Acyclovir pharmacokinetics in a patient on continuous ambulatory peritoneal dialysis.

• Acyclovir is an effective agent for the treatment of herpes virus infecti ons, howeve r, the pharmacokinet ics of the drug are altered in renal failure. We studied th is drug in a continuous ambulatory peritoneal dialysis (CAPO) patient who was immunocompromised and had cutaneous herpes infection. The elimination half-life (17.1 hours) was similar to that report ed for end-stage renal disease (ESRD) patients, while the volume of the central cornpart­ ment (29.6 U1 .73 m2) , the steady state volume of distribution (68.1 U1.73 m2 ) , and the total body clearance (48.3 mUmin/1.73 m2) were greater. The mean CAPO clearance was only 4.4 mUmin, with less than 10% of an adminis­ tered dose being recovered in the 24-hour dialysate. Further studies are needed to establish a dosing regimen for CAPO patients. © 1986 by the National Kidney Foundation , Inc. CYCLOVIR is a recently approved antiviral agent for the treatment of herpes virus infec­ tions. J The kidney is the major route for acyclovir elimination, and the dose of the drug must be mod­ ified when renal function is abnormal. Since pa­ tients with end-stage renal disease (ESRO) have abnormal immune defense mechanisms and are at increased risk for infections. >including those due to herpes virus, an understanding of drug handling in renal failure is essential. The pharmacokinetics of acyclovir in ESRO patients on maintenance he­ modialysis have been reported;' and dosing guide­ lines have been recommended," however, there are no data in continuous ambulatory peritoneal dialy­ sis (CAPO). We recently had the opportunity to study acyclovir kinetics in a CAPO patient.