Antiviral drugs

2.5–3.3 h

Chronic

High-dose chronic therapy has caused crystalluria and renal failure, leukopenia. Coma, seizures, renal failure after large acute overdoses. Hallucinations and confusion after IV administration.

2.5 h

16.3 and 17.4 mg/kg (case reports)

No renal dysfunction after treatment with probenecid and IV hydration.

128–149 h

Chronic

Headache, nasopharyngitis, cough, pyrexia, upper abdominal pain, fatigue, diarrhea, lactic acidosis, hepatomegaly.

2–2.3 h

—

Prodrug metabolized to active penciclovir.

3.3–4 h

1.14–8 times recommended dose (average, 4 times)

Seizures, renal impairment. One patient had seizures and died after receiving 12.5 g daily for 3 days.

3.5 h (IV)

4.8 h (oral)

Adults: 5–7 g or 25 mg/kg IV

Neutropenia, thrombocytopenia, pancytopenia, increased serum creatinine; 9 mg/kg IV caused a seizure; 10 mg/kg IV daily caused hepatitis.

Children: 1 g instead of 31 mg in a 21-month-old had no toxic effect; an 18-month-old received 60 mg/kg IV, was treated with exchange transfusion, and had no effect; a 4-month-old received 500 mg, was treated with peritoneal dialysis, and had no effect; 40 mg in a 2-kg infant caused hepatitis.

6–10 h

Delirium, hallucinations.

Extensive intracellular metabolism.

298 h

Up to 20 g acute ingestion

Hemolytic anemia, neutropenia, thrombocytopenia; suicidal ideation.

15–30 mg/kg IV

Reversible bone marrow toxicity reported after 3–5 courses of IV treatment. Systemic absorption is negligible after ophthalmic instillation. Ingestion of contents of one bottle (7.5 mL, 75 mg) unlikely to cause any adverse effects.

Prodrug promptly converted to acyclovir.

4 h

Rapidly converted to ganciclovir.

Rapid deamination to ara-hypoxanthine metabolite, whose half-life is 2.4–3.3 h

Chronic 1–20 mg/kg/d IV for 10–15 d

Nausea, vomiting, diarrhea, dizziness, ataxia, tremor, confusion, hallucinations, psychosis; decreased Hct, Hgb, WBC, platelets; increased AST, ALT, LDH. Poorly absorbed orally; no toxicity expected if one tube (3.5 g, 105 mg) ingested.

2.5–5.1 h

Bronchospasm.

Nucleoside (NRTIs) or nucleotide (NtRTIs) reverse transcriptase inhibitors

Lactic acidosis, mitochondrial toxicity, hepatotoxicity.

1.54 ± 0.63 h

Chronic

Diarrhea, nausea, vomiting; hypersensitivity (fatal reactions reported); perioral paresthesias.

7.5 h

≥60 mg/d

Nephrotoxicity.

1.5 ± 0.4 h

Chronic

Diarrhea, pancreatitis, peripheral neuropathy, salt overload with buffered product.

10 h

Chronic

Lactic acidosis and severe hepatomegaly with steatosis.