抗ウイルス剤の過剰投与により精神神経症状をきたした透析症例

Two patients with neurotoxicity caused by overdose of antiviral drugs during hemodialysis therapy

　抗ウイルス薬であるアシクロビルは腎排泄が主であり，腎機能障害患者では蓄積が起こりやすく，アシクロビル中毒を生じる危険性がある。アシクロビル常用量が投与され，精神神経症状を発現した慢性血液透析患者2例を経験した。両症例ともアシクロビル血中濃度は高値を示し，血液透析施行で症状が軽快した。

　Acyclovir and valacyclovir are efficient agents for virus infections of the herpes family. The kidneys are the main route of elimination of these drugs. In patients with end-stage renal disease,the half-life increases from 2.9 hours to 19.5 hours,increasing the possibility of serious adverse side effects such as neurotoxicity. We present two cases of acyclovir-induced neurotoxicity in patients with chronic renal failure under hemodialysis therapy. Their serum acyclovir concentrations were high（9.22μg/ml and 15.11μg/ml）with neuromental disturbance as confusions and speech difficulties. After meticulous hemodialysis,neurological symptoms were completely resolved. We conclude that for neurotoxicity caused by acyclovir overdose,immediate hemodialysis is efficient.