acyclovir and kidney care

[Fredismydog]

I have follicular lymphoma. I’m not interested in taking acyclovir as I was born with only one kidney. I’m wondering if anyone knows of an antiviral that doesn’t harm the renal function that can replace acyclovir?

thank you.

[AussieNeil Partner Administrator]

Do you have a kidney specialist that you can consult about this? According to Drugs,com, acyclovir, famciclovir and valacylovir, which provide prophylactic protection against shingles, all need to be administered appropriately with respect to renal impairment. You haven't shared whether you are being appropriately cautious or whether your kidney function is already impaired. I really think you need to consult with an expert on kidney health; particularly with respect to keeping your kidney healthy vs avoiding the challenge of keeping shingles pain under control should it ever develop. Challengingly, our risk of developing shingles increases with age while our kidney function worsens The recommended maximum doses of gabapentin and pregabalin for shingles and postherpetic neuralgia correspondingly reduce with renal function/age.

drugs.com/dosage/gabapentin...

drugs.com/dosage/pregabalin...

Extracts from drugs.com about acyclovir, famciclovir and valacylovir:

Acyclovir is primarily eliminated by the kidney. Patients with renal impairment may be at greater risk for neuro- and nephrotoxicity (including further deterioration in renal function, tubular damage and acute renal failure) from acyclovir due to decreased drug clearance. Therapy with acyclovir should be administered cautiously in patients with renal impairment. Dosage adjustments are recommended in patients with moderate to severe renal dysfunction.

drugs.com/disease-interacti...

Penciclovir, the active antiviral metabolite of famciclovir, is primarily eliminated by the kidney. Acute renal failure has been reported in patients with underlying renal disease who did not receive an appropriate dosage reduction. Dosage adjustments are recommended for patients with moderate to severe renal impairment (CrCl < 60 mL/min).

drugs.com/disease-interacti...

Valacyclovir is almost completely converted to acyclovir and L-valine by first-pass intestinal and/or hepatic metabolism; acyclovir is primarily eliminated by the kidney. Cases of acute renal failure and CNS side effects (including agitation, hallucinations, confusion, delirium, seizures, and encephalopathy) have been reported in patients with preexisting renal disease who received higher-than-recommended doses of valacyclovir for their level of renal function. Cases of acute renal failure have also been reported in patients receiving other nephrotoxic agents. Therapy with valacyclovir should be administered cautiously in elderly patients (with or without renal dysfunction) and patients receiving other nephrotoxic agents. Dosage reductions are recommended in patients with renal dysfunction. If acute renal failure and anuria occur, patients may benefit from hemodialysis until renal function is restored; valacyclovir should be discontinued if CNS side effects develop.

drugs.com/disease-interacti...

Are you up to date with your singles vaccination protection? (Shingrix) Some CLL specialists continue to recommend the antiviral irrespective of vaccination status. I presume it's the same with follicular lymphoma specialists. Given your understandable concern about keeping your kidney healthy, to me it makes sense to be vaccinated. If you've had chickenpox, (nearly all of us here have, given most of us were born before chicken pox vaccinations were added to childhood vaccination schedules), you're at increasing risk of developing shingles, particularly with a lymphoma diagnosis.

Neil

[Fredismydog in reply to AussieNeil]

Hello Neil,

Thank you for responding. I’m fully vaccinated from shingles and have never had it.I learned about only having one kidney four years ago. It’s perfectly healthy and I want to keep it that way. My oncologist states I need to take acyclovir for two years total. He also states I don’t “need to take it if I don’t want to”, and has knowledge of an alternative medication. Acyclovir helps the lymphoma from multiplying.

I said to my oncologist when I agreed to to chemo/ immunotherapy that I wouldn’t proceed with treatment if harm came to my kidney as I have no plans to ever take dialysis. I have seen a nephrologist once last September. He helped me understand proper monitoring since none of my many other MD’s weren’t familiar. He did put me on ramipril that lasted about a week before I ceased use due to side effects. I’m not one for medications since my body always reacts with the rarest of the side effects. I’ve always preferred nutrition and exercise to heal. I will send an email to the nephrologist asking his thoughts on acyclovir, if there’s a safer med, and how to monitor its use.

Thank you Neil.

[AussieNeil Partner Administrator in reply to Fredismydog]

It's good that you are just being proactive about maintaining the health of your kidney. I hope your nephrologist can help, because you do not want a shingles outbreak, believe me! (With respect to your statement that "Acyclovir helps the lymphoma from multiplying", I think you meant to say that acyclovir is an antiviral that stops the varicella/herpes zoster virus from multiplying, preventing a shingles outbreak )

Neil

[Fredismydog in reply to AussieNeil]

I was correct in stating acyclovir was prescribed as part of my lymphoma treatment.

I’ve never had shingles, chicken pox, and was vaccinated for shingles in 1/2020. I work in health care so I’ve always kept up on my shots.

Hopefully, I’ll find new information soon.

[SofiaDeo in reply to Fredismydog]

The acyclovir is part of a 3 drug protocol that is de rigueur when taking standard chemotherapeutic agents. Extremely immune suppressing treatments left patients at risk for opportunistic bacterial, viral, and fungal infections. Things that normally our bodies can take care of, but with heavy chemo they would overwhelm the system.

Nowadays, I see that doctors judiciously use 1 or more, depending on the treatment, as well as how a patient is responding to treatment. Since herpes viruses causing shingles are difficult to predict, especially with regard to who gets it worse, or has any lasting damage, IMO this one is recommended the most often. If one gets a fungal or bacterial infection, usually there aren't major aftereffects. With shingles, post herpetic neuralgia is painful & may never go away. Not to mention, if you happen to get it in your eyes it can be difficult to treat.

So I am reasoning that docs are recommending an antiviral like acyclovir to make *sure* you don't get shingles, or even an oral herpes lesion that may get infected after the vesicles break open. The underlying skin of a herpes vesicle is very thin.

[Fredismydog in reply to SofiaDeo]

Thank you SofiaDeo,

Hopefully the two part shingles vaccine I took in 2020 will keep me free of shingles….

[SofiaDeo in reply to Fredismydog]

There's data out indicating diet/supplementing lysine to lower lysine/arginine ratio can help drive any virus causing an outbreak back into the nerve root. So foods high in arginine compared to lysine (many nuts, seeds) should be avoided, and many people like me also take L-lysine supplements in addition. Change in diet as well as lysine supplement generally needs to happen, just taking lysine alone may not work.

ncbi.nlm.nih.gov/pmc/articl...

I've had shingles twice, and oral cold sores since I was a kid. The newer medications are good at tamping the virus down. I personally prefer valacyclovir to acyclovir. Since I've had herpes problems most of my life, I've tried virtually every medication for it as new ones come out hahaha!

Nota Bene: some of us immune compromised folk can also get strange combination outbreaks. In addition to my "classic shingles" problems, I also had an instance where the lesions on my back appeared to be a "mixed simplex-zoster", according to the doc. I am fortunate enough to have a prodrome of itching, tingling, shooting pain, and now I can contain if not outright prevent severe outbreaks by taking the med as soon as I can "feel" these changes. The valacyclovir is a huge tablet (1 gm) and makes me really nauseous, so I take it only when I must. I am OK with intermittent small instances of breakthrough lesions instead of taking the tablets constantly. Not everyone prodromes, so this won't work for everyone. Plus my immune globulins aren't suppressed; I imagine if I had low ones the doc would be wanting me to take the prophylactic meds.