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Drug - Drug Interactions Aciclovir Drug

Interactions

Aciclovir Drug Interactions

Valaciclovir is a prodrug of Aciclovir and therefore has the potential to interact similarly.

Aciclovir + Ciclosporin (Cyclosporine)

Aciclovir does not normally seem to affect ciclosporin levels nor worsen renal function,
but a very small number of cases of nephrotoxicity and increased ciclosporin levels have
been seen following concurrent use. Valaciclovir, a prodrug of aciclovir, is expected to
interact similarly.

The handful of cases where problems have arisen clearly indicate that renal function
should be well monitored if both drugs are given. The manufacturers recommend that
renal function is closely monitored if high doses of valaciclovir (more than 4 g daily) or
aciclovir infusion are given with ciclosporin.

Aciclovir + H2-receptor antagonists

Single-dose studies have found that cimetidine increases the AUC of valaciclovir and its
metabolite, aciclovir, but this is thought unlikely to be clinically important.

No action is generally needed. However, the manufacturers of valaciclovir recommend


considering an alternative H2-receptor antagonist if high-dose valaciclovir is used. A
similar interaction seems possible with aciclovir.

Aciclovir + Mycophenolate

No clinically significant pharmacokinetic interaction appears to occur between aciclovir


and mycophenolate. However, the manufacturers say that in renal impairment there may
be competition for tubular secretion and increased concentrations of both drugs may
occur. This is also possible with valaciclovir. A case report describes neutropenia in a
patient taking valaciclovir with mycophenolate.

Increased monitoring may be prudent in patients with reduced renal function.


Neutropenia is a rare adverse effect of valaciclovir alone. Nevertheless, bear the
possibility of an interaction in mind should neutropenia occur if mycophenolate is also
given.

Aciclovir + Probenecid

Probenecid reduces the renal excretion of aciclovir and valaciclovir and therefore
increases their plasma levels.

Dose alterations are unlikely to be needed due to the wide therapeutic range of aciclovir
and valaciclovir, although the manufacturer recommends that alternatives to probenecid

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Drug - Drug Interactions Aciclovir Drug
Interactions

could be considered if high-dose valaciclovir is given. A clinically relevant interaction is


more likely in those with reduced renal function.

Aciclovir + Theophylline

Preliminary evidence suggests that aciclovir can reduce the clearance of theophylline
(and therefore possibly aminophylline) by about 30%. Evidence for valaciclovir appears
to be lacking although it would be expected to interact similarly.

Evidence appears to be limited. Be alert for an increase in the adverse effects of


theophylline (nausea, headache, tremor) if aciclovir or valaciclovir is added, and consider
monitoring theophylline levels.

Refer: Stockley’s Drug Interactions

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