Possible Valacyclovir-Related Neurotoxicity and Aseptic Meningitis

Olin, Jacqueline L.; Gugliotta, Joseph L.

doi:10.1345/aph.1d171

Cited by 23 publications

(18 citation statements)

References 15 publications

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“…Perhaps, because VACV is more rapidly absorbed, VAN may develop unexpectedly, especially in elderly patients and those with renal failure. Linssen-Schuurmans et al [3] first reported VAN in 1998, and they and others have reported 20 cases since then [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] (Table 1). ACV neurotoxicity usually appears within the first 24 to 72 h of treatment, with renal failure and neurotoxicity, and complete recovery usually follows within 2 to 7 days after treatment is discontinued [18].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Valacyclovir neurotoxicity: clinical experience and review of the literature

Asahi

Tsutsui

Wakasugi

et al. 2009

Euro J of Neurology

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Valacyclovir (VACV) is used increasingly to treat herpes zoster, although neuropsychiatric symptoms [VACV neurotoxicity (VAN) or acyclovir neurotoxicity], may accompany use of this drug. To promote awareness of this rare condition, we describe here two clinical cases of VAN we previously reported and review 20 cases from the literature. In all cases, chronic or acute renal failure preceded VAN. The symptoms of VAN varied, but disturbances of consciousness and hallucination occurred most commonly. When acute renal failure was due to the drug, recovery from both the disturbance of consciousness and renal failure followed within several days after discontinuation of VACV. Early recognition and diagnosis will ensure effective treatment of VAN.

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Section: Discussionmentioning

confidence: 99%

“…Linssen‐Schuurmans et al. [3] first reported VAN in 1998, and they and others have reported 20 cases since then [3–17] (Table 1). ACV neurotoxicity usually appears within the first 24 to 72 h of treatment, with renal failure and neurotoxicity, and complete recovery usually follows within 2 to 7 days after treatment is discontinued [18].…”

Section: Discussionmentioning

confidence: 99%

Valacyclovir neurotoxicity: clinical experience and review of the literature

Asahi

Tsutsui

Wakasugi

et al. 2009

Euro J of Neurology

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“…Unfortunately, almost all authors do not report the specific clinical presentation of the occurring headache. In some cases, the headache is described to be global, progressive and intense [6], other patients have pressure-like pain [7], sometimes the headache is constant and frontally localized [8] and others have a recurrent headache [9]. Single case reports show that headache in aseptic meningitis might be migraine-like [10][11][12] and even sufficiently treated with subcutaneous application of sumatriptan [10].…”

Section: Clinical Presentation Of Headache In Drug-induced Aseptic Mementioning

confidence: 99%

Headache in Drug-Induced Aseptic Meningitis

Holle

Obermann

2015

Curr Pain Headache Rep

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Drug-associated headache is a quite common phenomenon, e.g. as a side effect of distinct substances such as nitric oxide or as a result of medication overuse of analgesic drugs. A different drug-associated headache entity is headache in drug-induced aseptic meningitis (DIAM). This is a rare disorder and only described in few case reports or smaller case series. One of the main clinical features of DIAM despite fever is headache. Based on the literature, no typical or even pathognomonical clinical presentation of this headache entity can be described. Sometimes, migrainous features might be present, and treatment response to triptans was reported in single case reports. Headache in DIAM seems to be emerging from sterile meningeal inflammation, which is suggested to represent the underlying pathology in DIAM. Headache in DIAM usually ceases when treated sufficiently, mainly through termination or withdrawal of the causing agent. Migraine as a predisposing factor of DIAM has been discussed previously but remains unproven.

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“…Other antimicrobial drugs have been implicated in drug-induced aseptic meningitis [5], for example. amoxicillin [14,52,53], cephalosporins [26,54], rifampicin [28], valacyclovir [55], and ornidazole [56].…”

Section: Antimicrobial Drugsmentioning

confidence: 99%

Drug‐induced aseptic meningitis: a mini‐review

Yéléhé‐Okouma

Czmil-Garon

Pape

et al. 2018

Fundamemntal Clinical Pharma

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Aseptic meningitis associates a typical clinical picture of meningitis with the absence of bacterial or fungal material in the cerebrospinal fluid. Drug-induced aseptic meningitis (DIAM) may be due to two mechanisms: (i) a direct meningeal irritation caused by the intrathecal administration of drugs and (ii) an immunologic hypersensitivity reaction to a systemic administration. If the direct meningeal irritation allows a rather easy recognition, the immunologic hypersensitivity reaction is a source of challenging diagnostics. DIAM linked to a systemic treatment exerts typically an early onset, usually within a week. This period can be shortened to a few hours in case of drug rechallenge. The fast and spontaneous regression of clinical symptoms is usual after stopping the suspected drug. Apart from these chronological aspects, no specific clinical or biological parameters are pathognomonic. CSF analysis usually shows pleiocytosis. The proteinorachia is increased while glycorachia remains normal. Underlying pathologies can stimulate the occurrence of DIAM. Thus, systemic lupus erythematosus appears to promote DIAM during NSAID therapy, especially ibuprofen-based one. Similarly, some patients with chronic migraine are prone to intravenous immunoglobulin-induced aseptic meningitis. DIAM will be mainly evoked on chronological criteria such as rapid occurrence after initiation, rapid regression after discontinuation, and recurrence after rechallenge of the suspected drug. When occurring, positive rechallenge may be very useful in the absence of initial diagnosis. Finally, DIAM remains a diagnosis of elimination. It should be suggested only after all infectious causes have been ruled out.

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Possible Valacyclovir-Related Neurotoxicity and Aseptic Meningitis

Abstract: Healthcare providers should be aware of valacyclovir as a possible cause of drug-induced aseptic meningitis.

Cited by 23 publications

References 15 publications

Valacyclovir neurotoxicity: clinical experience and review of the literature

Valacyclovir neurotoxicity: clinical experience and review of the literature

Headache in Drug-Induced Aseptic Meningitis

Drug‐induced aseptic meningitis: a mini‐review

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