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Acyclovir dosing in obese patients have: Prospective Evaluation of Adjusted Body Weight Dosing of Acyclovir in Obesity

Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information. Participants were predominately clinical pharmacists.

Matthew Cox
Wednesday, March 3, 2021
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  • Statistical analysis was performed using SPSS software, version More Information.

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  • While previous data 1011 have shown that using TBW for dose determination leads i excessive acyclovir exposure in obese patients, our study found that dosing by IBW will provide substantially lower exposure than in nonobese controls. Future research is needed to verify this finding and to explore appropriate dosing in this population and in other classes of obesity.

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Drug Information available for: Acyclovir Acyclovir sodium. Receive exclusive offers and updates from Oxford Academic. Medically reviewed by Drugs. He was 5 ft 7 in tall and weighed

Population pharmacokinetics of acyclovir in children and young people with malignancy after administration of intravenous ;atients or oral valacyclovir. Looking obese your next opportunity? Furthermore, there were no differences between groups in trough concentrations for any troughs obtained throughout vancomycin therapy. Although more patients in the nephrotoxicity group received vancomycin, there were no differences in maximum cumulative daily dosage, maximum total dosage, frequency of dosing, or initial trough values. Google Scholar. Single-dose pharmacokinetics of acyclovir. A single study evaluated the pharmacokinetics of acyclovir in 7 morbidly obese patients and 5 normal-weight patients and displayed similar pharmacokinetics between groups [ 4 ].

Published online Feb To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. See Contacts and Locations. Although some weight-based antimicrobials have recommendations for use of either actual body weight ABW or ideal body weight IBWmany of these drugs have little evidence available to guide clinician dosing. Adjusted body weight was not evaluated in this study. Prepublished online Jan Acyclovir pharmacokinetics.

Journal of Pharmacy Practice. Last updated on Feb 26, Limited data provide conflicting recommendations for dosing in obese patients, and future studies are necessary to optimize patient outcomes and prevent toxicity. Address correspondence to Dr.

Usual Adult Dose for Herpes Simplex - Mucocutaneous/Immunocompromised Host

They will have blood drawn once prior to the first dose of acyclovir and 10 times thereafter, over a total time period of 12 hours. These were utilized to evaluate each analytic run. Google Preview. Valaciclovir for the suppression of recurrent genital HSV infection: a large-scale dose range-finding study.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Patients were identified through use of clinical decision support software TheraDoc. Patient Demographics. External link. The lower limit of quantitation for acyclovir was 0.

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He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. Study Start Date :. Wong, A. Medically reviewed by Drugs. Evaluation of discharge prescribing after rescheduling of gabapentin as a controlled substance.

Unfortunately, trials evaluating the PD of i. Financial support. Dosiing comment will be reviewed and published at the journal's discretion. Patients receiving acyclovir as standard of care will be enrolled into this study. Samples were analyzed within 30 days of collection at NMS Labs Willow Grove, PA using liquid chromatography-tandem mass spectrometry that was internally validated. FIG 1.

Citing articles via Web of Science Estimated Enrollment :. Use: For the secondary prophylaxis of recurrent HSV disease. Oxford University Press is a department of the University of Oxford.

INTRODUCTION

Medically reviewed by Drugs. Each day news feeds are analysed, websites searched and various additional sources of information visited. Abstract Purpose.

Systemic clearance was substantially higher in the obese than normal-weight patients mean, Journal List Antimicrob Agents Chemother v. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. However, patients in both groups had comparable vancomycin dosing and trough concentrations.

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Advance article alerts. Outcome Measures. Antimicrob Agents Chemother 19 — Journal List Antimicrob Agents Chemother v. In patients who are obese, clinicians are often challenged regarding how to properly address medical issues, especially with medications that require dosing based upon body weight.

The patients obese divided into 2 groups: those who developed toxicity cases and those who did not controls. Utilization of IBW for dose calculation of i. Unfortunately, there currently is not a consensus on how acyclovir should be dosed in these patients. Layout table for location contacts Contact: Pam Bunner bunnerp wvumedicine. Antimicrob Agents Chemother — Furthermore, there were no differences between groups in trough concentrations for any troughs obtained throughout vancomycin therapy. Abstract The current recommendations for intravenous i.

Usual Adult Dose for Herpes Simplex - Mucocutaneous/Immunocompetent Host

The only literature to support this recommendation is a single PK analysis comparing morbidly obese MO to normal-weight NW healthy females, presented as an abstract in by Davis and colleagues Correspondence: K. Although more patients in the nephrotoxicity group received vancomycin, there were no differences in maximum cumulative daily dosage, maximum total dosage, frequency of dosing, or initial trough values. Mean acyclovir concentration-time curve for normal-weight and morbidly obese patients. Am J Med ; 84 : —

Study Type :. Achclovir was also given moxifloxacin mg i. Use: For known or suspected neonatal HSV. A case of acyclovir-induced acute renal failure in an obese patient is described. As patient weight increased, respondents were more apt to dose based on an adjusted body weight, with dosing in the obese and morbidly obese showing a clear lack of consistency. Use: For the secondary prophylaxis of recurrent HSV disease.

Your comment will be reviewed and published at the journal's discretion. FDA Safety Alerts for all medications. Subscribe to our newsletters. Safety and efficacy of buccal tablets have not been established in pediatric patients. National Library of Medicine U. Permissions Icon Permissions.

Save this study. If you originally registered with a username please use that to sign in. Use: For the secondary prophylaxis of recurrent HSV disease.

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  • Use: For the treatment of HSV encephalitis. Prospective Evaluation of Adjusted Body Weight Dosing of Acyclovir in Obesity The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.

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  • A year-old white man arrived at the emergency department complaining of confusion and disorientation. Sign in via your Institution Sign in.

Eligibility Criteria. Subscribe to our newsletters. April 10th. An obese man receiving excessive doses of i.

Citing articles via Web of Science Limited data provide acycolvir recommendations for dosing in obese patients, and future studies are necessary to optimize patient outcomes and prevent toxicity. Sign In or Create an Account. Last Update Posted : December 17, HIV-Infected Adults guideline dosing : -Post-Exposure Prophylaxis: mg orally 5 times a day for 5 to 7 days; begin 7 to 10 days after exposure Comments: -Varicella-zoster immune globulin is the preferred therapy for postexposure prophylaxis; oral antiviral therapy may be used when passive immunization is not possible; if antiviral therapy is used, varicella vaccines should not be given for at least 72 hours following last dose. Search Menu. Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information.

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A total of approximately tablespoons of blood will be drawn for this study. Intensive Care Med ; 33 : — None of the above grant funding was for the submitted research project.

  • Serial plasma concentrations were obtained and compared.

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  • Data collected included demographic information and dosing of acyclovir, given consistent patient cases with varying patient weight.

Although some weight-based antimicrobials have recommendations for use of either actual body weight ABW or ideal body weight IBWmany of these drugs have little evidence available to guide clinician dosing. Please refer to this study by its ClinicalTrials. Laskin and colleagues reported a similar AUC of They identified a higher C max Thank you for submitting a comment on this article.

An obese man receiving excessive doses of i. Study Description. Add comment Close comment form modal. FDA Resources. However, limited data support this recommendation, and recent data suggest this may lead to underdosing. Jeni Norstrom.

Although obesity was the only haave difference between the cases and controls, the total daily acyclovir dosage did not differ between the 2 groups. The median total daily dose IQR was — mg, with a median dose of Altered PK are often present in patients that are critically ill 18 ,

Study record managers: refer to the Data Element Definitions if submitting registration or results information. FDA Safety Alerts for all medications. Submit a comment. Your comment will be reviewed and published at the journal's discretion. Eligibility Criteria. Use: For the treatment of Herpes Simplex Encephalitis. Warning You have reached the maximum number of saved studies

Acyclovir dosing in obese patients have total of 14 patients were enrolled and completed the study 7 patients per group. Identification of these risk factors will aid clinicians in providing an evidence-based approach to current clinical practice, thus providing a higher quality of care to all patients receiving acyclovir. The objective of this study was to evaluate the currently recommended dosing strategy for i. Support Center Support Center. Acute renal failure and coma after a high dose of oral acyclovir. Antimicro Agents Chemother 45 — Learn More.

Further investigations on nephrotoxicity in qcyclovir on both vancomycin and acyclovir are warranted. The purpose of this study was to determine the prevalence of and risk factors for acyclovir-associated nephrotoxicity in an adult population at the University of Mississippi Medical Center UMMC. Center for Disease Control and Prevention. New issue alert. This article has been cited by other articles in PMC.

Jeni Norstrom. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity. Acyclovir Dosage Medically reviewed by Drugs. Oxford Academic. New issue alert.

Contacts and Locations. Please refer to this study by its ClinicalTrials. Use: For the treatment of HSV encephalitis. Download all slides.

Baseline serum creatinine values were similar between groups, with a median initial value of 0. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Try out PMC Labs and tell us what you think. Study Start Date :. On January 1,the Joint Commission released standards recommending antibiotic timeout at 48 hours as part of a targeted antimicrobial stewardship effort [ 15 ]. Comments 0. Single-dose pharmacokinetics of acyclovir.

Eligibility Criteria. He was 5 ft 7 in tall and weighed Estimated Primary Completion Date :. Your comment will be reviewed and published at the journal's discretion.

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New issue alert. Use: For the secondary prophylaxis of recurrent HSV disease. This article is also available for rental through DeepDyve. Sign in via your Institution Sign in.

You have entered an invalid code. This article is also available for rental through DeepDyve. Oxford University Press is a department of the University of Oxford. Google Scholar. You must accept the terms and conditions.

Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Please refer to this study by its ClinicalTrials. August 25, Key Record Dates. Submit Cancel. Federal Government.

DALI: defining antibiotic levels in intensive care unit patients: are current beta-lactam antibiotic doses sufficient for critically ill patients? Prepublished online Jan Submit Cancel. Pharmacokinetics of oral acyclovir in neonates and in infants: a population analysis.

Monthly Newsletter. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Your comment will be reviewed and published at the journal's discretion. Evaluation of discharge prescribing after rescheduling of gabapentin as a controlled substance. Last updated on Feb 26,

Finally, these were cancer patients receiving active chemotherapy treatments, but we have no reason to believe this would affect the PK characteristics with i. European Commission, Brussels, Belgium. Adjusted body weight was not evaluated in this study. August 25, Key Record Dates. They identified a higher C max

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Use: For the patuents of herpes simplex labialis cold sores. Google Scholar. April 10th. You must accept the terms and conditions. Last Update Posted : December 17, Obese patients should be dosed at the recommended doses using Ideal Body Weight IBW Elderly patients are more likely to have reduced renal function and require dose reduction. Sign in Don't already have an Oxford Academic account?

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Obeese escalating doses result in linear increases in AUC and similar V 1517caution should be exercised in acyclovir dosing in obese patients have these data to other dosing regimens. Although obesity was a risk factor for toxicity in our study, we did not observe a difference in the rates of acyclovir-associated nephrotoxicity regardless of weight utilized for dosing calculations. Potential conflicts of interest. Joint Commission on Hospital Accreditation. Comment title. Open in new tab. Adjusted body weight was not evaluated in this study.

  • As expected, the patients who developed nephrotoxicity displayed higher serum creatinine values, with the peak values observed at a median IQR of day 4. Unfortunately, published PK data specific to obese patients are limited.

  • I agree to the terms and conditions. Use: For the treatment of Herpes Simplex Encephalitis.

  • Serial plasma concentrations were obtained and compared. Samples were analyzed within 30 days of collection at NMS Labs Willow Grove, PA using liquid chromatography-tandem mass spectrometry that was internally validated.

  • We have no conflicts of interest to report. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

  • Talk with your doctor and family members or friends about deciding to join a study. Oxford Academic.

Use: For the acute treatment of herpes zoster shingles. Always hqve your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Article Navigation. Hemodialysis: Adjust dosing interval to provide an additional dose after each dialysis Peritoneal Dialysis: No supplemental dose necessary after adjustment of the dosing interval. Use: For the secondary prophylaxis of recurrent HSV disease.

These patients will already be qcyclovir for other reasons, and will not be required to make additional trips to the hospital. Layout table for location contacts Contact: Pam Bunner bunnerp wvumedicine. Use: For HIV-infected person who has had close contact with a person who has active varicella or herpes zoster and is susceptible to the virus e. Acyclovir was subsequently discontinued, as were all i.

August 25, Key Record Dates. To purchase short term access, pwtients sign in to your Oxford Academic account above. Don't have an account? Use: For HIV-infected person who has had close contact with a person who has active varicella or herpes zoster and is susceptible to the virus e. Layout table for location contacts Contact: Pam Bunner bunnerp wvumedicine.

  • View all jobs. Acyclovir pharmacokinetics in morbid obesity.

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  • Data collected included demographic information and dosing of acyclovir, given consistent patient cases with varying patient weight.

Open in new tab. Nephrotoxicity was defined according to the RIFLE criteria, which were calculated with the highest serum creatinine value during acyclovir therapy [ 8 ]. Am J Med 73 — Antimicrob Agents Chemother — Know the risks and potential benefits of clinical studies and talk to your health care provider before participating.

Furthermore, there were no differences between groups in trough concentrations for any troughs obtained throughout vancomycin therapy. Correspondence: K. Second, these patients were all receiving acyclovir for prophylaxis and were not actively infected or critically ill. PLoS Med ; 6 : e Quantification of lean body weight.

Estimated Study Completion Date :. Ten obese patients and 10 matched control non-obese patients will be enrolled. The optimal hvae was utilized to have simulated data for estimation of the individual patients' IC 50 s at steady state with h dosing intervals. Approximately one-fifth of the patients included developed acyclovir-associated nephrotoxicity after approximately 5 days of therapy. While these data are based on this single-dose analysis, we expect that dosing over several days would provide similar results.

Glenn Wysock. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Use: For the secondary prophylaxis of recurrent HSV disease. April 10th. Subscribe to our newsletters.

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Antimicrob Agents Chemother 45 — Patients who developed nephrotoxicity were treated with acyclovir for a median IQR acyclovri 8. A prospective evaluation of IBW to dose acyclovir in obese patients has not been published. The objective of the present study was to evaluate the PK of i. Controversy exists regarding which of these PD parameters is most important in predicting clinical success.

You must accept the terms and conditions. Study Description. Citing articles via Web of Science Address correspondence to Dr. Most users should sign in with their email address.

Unfortunately, trials evaluating the PD of i. Talk with your doctor and family members or friends about deciding to join a study. Identification of these risk factors will aid clinicians in providing an evidence-based approach to current clinical practice, thus providing a higher quality of care to all patients receiving acyclovir. Zovirax Acyclovir Sodium. Patients were identified through use of clinical decision support software TheraDoc.

Use: For known or suspected neonatal HSV. He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information.

For general information, Learn About Clinical Studies. Acyclovir was prepared in ml of 0. Health, United States, with special feature on prescription drugs. Your comment will be reviewed and published at the journal's discretion. Although obesity was a risk factor for toxicity in our study, we did not observe a difference in the rates of acyclovir-associated nephrotoxicity regardless of weight utilized for dosing calculations.

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More on this topic Association Between Vancomycin Area Under the Curve and Nephrotoxicity: a single center, retrospective cohort study in a veteran population. The PK parameters observed in the current study for NW patients are similar to those previously reported for healthy, nonobese patients. Acyclovir, approved in for the treatment of herpes simplex virus HSVis one such drug that is dosed according to weight [ 3 ]. Acyclovir administration. Center for Disease Control and Prevention. The conclusions of this study remain to be validated. The decision to not use TBW in dosing morbidly obese patients is supported by at least one case of an obese patient developing acyclovir-induced renal failure following i.

FDA Resources. Overview of acyclovir pharmacokinetic disposition in adults and children. Journal List Antimicrob Agents Chemother v. Health, United States, with special feature on prescription drugs. Add comment Close comment form modal.

A lumbar puncture revealed abnormal cerebral spinal fluid. Subscribe to our newsletters. Search for terms x.

  • Estimated Study Completion Date :.

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  • Arch Intern Med — Eligibility Criteria.

  • Last Update Posted : December 17,

  • No patients experienced loss of renal function beyond 4 weeks.

Ten obese patients and 10 matched control non-obese patients hzve be enrolled. Hide glossary Glossary Study record managers: obese patients have to the Data Element Definitions if submitting registration or results information. While these data are based on this single-dose analysis, we expect that dosing over several days would provide similar results. Sign In. Potential conflicts of interest. Drug Intell Clin Pharm 8 — Actual sample times obtained from initiation of the dose were calculated from the case report forms and used as primary input data.

Thank you for submitting a comment on this article. Federal Government. Lastly, although we attempted to be thorough with our data collection, there may be another factor associated with acyclovir-associated toxicity that we did not examine. In progress issue alert. Patient Demographics. More Information.

  • Additionally, we had a small sample in our microbiologically evaluable population, so we cannot suggest improved or worsened efficacy based upon dosing strategy. Gentamicin therapy.

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  • Volume To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below.

  • While these data are based on this single-dose analysis, we expect that dosing over several days would provide similar results. FIG 1.

Statistical analysis was performed using SPSS software, version Clin Infect Dis 58 — Your comment will be reviewed and published at the journal's discretion. The only literature to support this recommendation is a single PK analysis comparing morbidly obese MO to normal-weight NW healthy females, presented as an abstract in by Davis and colleagues

Please xosing to this study by its ClinicalTrials. His discharge diagnoses included encephalitis with possible viral origin and acyclovir-induced nephrotoxicity. You do not currently have access to this article. Thank you for submitting a comment on this article. Purchase Subscription prices and ordering Short-term Access To purchase short term access, please sign in to your Oxford Academic account above.

Monitoring : -Assess renal function prior to therapy Patient advice : -Patients should be advised to maintain adequate hydration during therapy. Permissions Icon Permissions. See Contacts and Locations.

Acyclovir was subsequently discontinued, as dosinv all i. FDA Resources. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Hemodialysis: Adjust dosing interval to provide an additional dose after each dialysis Peritoneal Dialysis: No supplemental dose necessary after adjustment of the dosing interval. Use: For secondary prophylaxis and treatment of recurrent HSV disease.

They will have blood drawn once prior to the first dose of acyclovir and 10 times thereafter, over a total time period of 12 hours. A diagnosis of herpes encephalitis was considered, and the patient was empirically treated with i. Receive exclusive offers and updates from Oxford Academic. Wong, A. Please refer to this study by its ClinicalTrials. Add comment Cancel.

New issue alert. These were utilized to evaluate each analytic run. J Antimicrob Chemother 44 — Drug Intell Clin Pharm 8 — External link. A double-blind, randomized study assessing the equivalence of valacyclovir mg once daily versus mg twice daily in the episodic treatment of recurrent genital herpes. August 25, Key Record Dates.

Both obesity and concomitant vancomycin usage were independent factors that increased risk for the development of acyclovir-associated nephrotoxicity. There were no differences in receipt or type of IV hydration or concomitant nephrotoxic agents, other than receipt of vancomycin. Financial support. This work was supported by internal funding. Approved: new antimicrobial stewardship standard.

J Infect Dis — A large scale, placebo-controlled, dose-ranging trial of peroral valaciclovir for episodic treatment of recurrent herpes genitalis. In obese patients, minimal data exist for appropriate dosing of acyclovir to decrease the rates of nephrotoxicity. On January 1,the Joint Commission released standards recommending antibiotic timeout at 48 hours as part of a targeted antimicrobial stewardship effort [ 15 ]. However, patients in both groups had comparable vancomycin dosing and trough concentrations. Altered PK are often present in patients that are critically ill 18 ,

  • Study record managers: refer to the Data Element Definitions if submitting registration or results information.

  • Use: For the secondary prophylaxis of recurrent HSV disease.

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European Commission, Brussels, Belgium. Samples were analyzed within 30 days of collection at NMS Labs Willow Eosing, PA using liquid chromatography-tandem mass spectrometry that was internally validated. Listing a study does not mean it has been evaluated by the U. Clin Pharmacol Ther 54 — Our study suggests that, in institutions that frequently utilize IV acyclovir, antimicrobial stewardship should target obese patients on concomitant vancomycin.

Related acyclivir in Web of Science Google Scholar. To purchase short term access, please sign in to your Oxford Academic account above. Issue Section:. He also had a history of cyst drainage on the back of his neck, with recent drainage emitting a foul odor, and suffered recurrent herpes cold sores on his chin. Federal Government. Study Start Date :. Jeni Norstrom.

Acyclovir is a nucleoside analogue that possesses activity against the herpes family of viruses, including herpes simplex virus type 1 and 2 HSV-1 and HSV-2 and varicella-zoster virus VZV 3. Support Center Support Center. Lastly, known risk factors for nephrotoxicity were also collected, including concomitant nephrotoxic agents aminoglycosides, vancomycin, angiotensin-converting enzyme inhibitors, and radiocontrast dye and hydration status concomitant fluids.

Warning You have reached the maximum number of saved studies Secondary Outcome Measures : Half-life of acyclovir in obese and non-obese patients [ Time Frame: 12 hours ] Maximum concentration Cmax of acyclovir in obese and acyclovir dosing in obese patients have patients [ Time Frame: 12 hours ] Time to maximum concentration Tmax of acyclovir in obese and non-obese patients [ Time Frame: 12 hours ] Volume of distribution Vd of acyclovir in obese and non-obese patients [ Time Frame: 12 hours ] Systemic Clearance of acyclovir in obese and non-obese patients [ Time Frame: 12 hours ] Time that concentration is above IC50 for varicella and herpes viruses in obese and non-obese patients [ Time Frame: 12 hours ]. Don't have an account? Study Type :. Use: For the treatment of herpes simplex labialis cold sores.

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Approximately one-fifth of the patients included developed acyclovir-associated nephrotoxicity after approximately 5 days of therapy. Within-run kn for the high, low, and lowest observable quantities assay were 2. Among those who developed nephrotoxicity, there were 11 9. None of the above grant funding was for the submitted research project. European Commission, Brussels, Belgium.

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  • A total of approximately tablespoons of blood will be drawn for this study. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision.

  • Clinically relevant was defined as variables with prior documentation of contributing to the development of nephrotoxicity. Preventive Services Task Force.

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Antimicrob Agents Chemother 19 — Acyclovir dosing in obese patients have J Health Syst Pharm ; 66 : — Among those who developed nephrotoxicity, there were 11 9. Further investigations on nephrotoxicity in patients on both vancomycin and acyclovir are warranted. Additionally, risk factors for the development of nephrotoxicity, including the effect of obesity and dosing strategy, were assessed. Although more patients in the nephrotoxicity group received vancomycin, there were no differences in maximum cumulative daily dosage, maximum total dosage, frequency of dosing, or initial trough values.

Infigratinib Phosphate. Acyclovir was subsequently discontinued, as were all i. They will have blood drawn once prior to the first dose of acyclovir and 10 times thereafter, over a total time period of 12 hours. A diagnosis of herpes encephalitis was considered, and the patient was empirically treated with i.

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