Valacyclovir/Acyclovir 
===============================================

**PD Dialyzability**: Likely

Pharmacokinetic Parameters [1]_ [2]_
--------------------------------------

======= ====== ======
/////// |pk|   |p1|
======= ====== ======
|pk1|   |v1|   |p2|
|pk2|   |v2|   |p3|
|pk3|   |v3|   |p4|
|pk4|   |v4|   |p5|
|pk5|   |v5|   |p6|
|pk6|   |v6|   |p7|
|pk7|   |v7|   |p8|
======= ====== ======

CAPD Dosing: [2]_ [3]_ [4]_
----------------------------
* Valacyclovir 500mg PO Q24H

CCPD Dosing:
-------------
* No literature identified. Extrapolate dosing from CAPD dosing recommendations.

Indication Specific PD Dosing:
----------------------------------
* None identified

Literature Summary:
----------------------

+--------+----------------------------------+--------------+----------------------------------------------------------------------------+-------------------+
| Title  | Patient                          | Intervention | Outcome                                                                    | Note              |
+========+==================================+==============+============================================================================+===================+
| |L1|   | * CAPD                           | |L2|         | * Acyclovir concentration                                                  | * |L3|            |
|  [5]_  | * 12 patients otherwise healthy  |              | * |L4|                                                                     |                   |
+--------+----------------------------------+--------------+----------------------------------------------------------------------------+-------------------+
| |L5|   | * CAPD                           | |L6|         | * Valacyclovir was discontinued                                            | * |L7|            |
|  [6]_  | * 72 year old female             |              | * |L8|                                                                     |                   |
|        | * |L9|                           |              |                                                                            |                   |
|        | * |L10|                          |              |                                                                            |                   |
+--------+----------------------------------+--------------+----------------------------------------------------------------------------+-------------------+
| |L11|  | * CCPD                           | |L12|        | * Patient recovered and discharged                                         | * No ADR reported |
|  [7]_  | * 30 year old female             |              |                                                                            |                   |
|        | * |L13|                          |              |                                                                            |                   |
|        | * |L14|                          |              |                                                                            |                   |
+--------+----------------------------------+--------------+----------------------------------------------------------------------------+-------------------+

References
------------

.. [1] Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(suppl_1):D668–72.  

.. [2] American Pharmacist Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals [Internet]. Hudson, Ohio: American Pharmacist association; 2012 [cited 2018 Jan 24]. Available from: http://online.lexi.com.login.ezproxy.library.ualberta.ca/lco/action/home?siteid=1

.. [3] Aronoff GR. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th ed. Philadelphia, PA: American College of Physicians; 2007. 

.. [4] Adjusting oral antibiotics to estimated creatinine clearance [Internet]. [cited 2018 Jan 24]. Available from: http://www.vhpharmsci.com/VHFormulary/Tools/ADJUSTING%20ORAL%20ANTIBIOTICS.pdf

.. [5] Stathoulopoulou F, Dhillon S, Thodis H, Stathakis C, Vargemezis V. Evaluation of valaciclovir dosage reduction in continuous ambulatory peritoneal dialysis patients. Nephron. 2002;91(1):164–166. 

.. [6] Pipili C, Pantelias K, Deda E, Tsiamalos P, Kostis E, Grapsa E. Intensification of peritoneal dialysis improves valacyclovir neurotoxicity. Ren Fail. 2013;35(2):289–290. 

.. [7] Liesker J, van Elsacker-Niele AM, Blanken R, Halma C. A cloudy bag and genital ulcers. Clin Nephrol. 2006;65(5):378–379. 

.. |pk| replace:: Valacyclovir
.. |pk1| replace:: Molecular Weight (Da)  
.. |pk2| replace:: Plasma Protein Binding (%)
.. |pk3| replace:: Volume of Distribution (L/Kg) 
.. |pk4| replace:: Hepatic Metabolism 
.. |pk5| replace:: Excreted Unchanged (%) 
.. |pk6| replace:: Half-Life; Normal Renal Function (hours)
.. |pk7| replace:: Half-Life; ESRD (hours) 
.. |v1| replace:: 324.34
.. |v2| replace:: 13-18
.. |v3| replace:: No Data
.. |v4| replace:: Valacyclovir is converted to acyclovir by hepatic metabolism
.. |v5| replace:: <1
.. |v6| replace:: 2.3-3.3
.. |v7| replace:: No Data
.. |p1| replace:: Acyclovir
.. |p2| replace:: 225.20
.. |p3| replace:: 15-30
.. |p4| replace:: 0.7
.. |p5| replace:: Small amounts of acyclovir is metabolized in the liver
.. |p6| replace:: 40-70
.. |p7| replace:: 2.1-3.8
.. |p8| replace:: 20
.. |L1| replace:: Evaluation of valaciclovir dosage reduction in continuous ambulatory peritoneal dialysis patients.
.. |L2| replace:: Single dose of valacyclovir 500mg PO.
.. |L3| replace:: 1 patient developed tinnitus and headache.
.. |L4| replace:: 500mg daily regimen produced therapeutic concentration for herpes zoster (HZV) or varicella zoster (VZV) viruses.
.. |L5| replace:: Intensification of peritoneal dialysis improves valacyclovir neurotoxicity.
.. |L6| replace:: Valacyclovir 3g PO daily.
.. |L7| replace:: Valacyclovir induced neurotoxicity.
.. |L8| replace:: PD schedule was intensified to six, 2L bag exchanges daily.
.. |L9| replace:: Prescribed valacyclovir for vesicular herpes zoster eruption.
.. |L10| replace:: Presenting with confusion and visual hallucination, dysesthesia, impaired coordination, and reported experience of nightmares.
.. |L11| replace:: A cloudy bag and genital ulcers.
.. |L12| replace:: Valacyclovir 500mg PO once daily x 14 days.
.. |L13| replace:: Presenting with abdominal pain, a cloudy effluent, and genital ulcers.
.. |L14| replace:: Diagnosed with peritonitis secondary to genital herpes.