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Resumen Presentamos el caso de un varón de 63 años, inmunocompetente, con una necrosis retinal aguda (NRA) unilateral. Consultó por visión borrosa, dolor ocular, fotofobia y cefalea. Se confirmó una papilitis y coriorretinitis periférica asociada a vasculitis e isquemia retinal periférica. El estudio molecular por RPC de humor acuoso detectó la presencia de virus varicela zoster. El paciente fue tratado con terapia combinada con corticoesteroides orales, aciclovir oral/intravenoso, ganciclovir intravítreo semanal y luego valaciclovir oral por tres meses. Se demostró una disminución progresiva de la carga viral en el humor acuoso durante el tratamiento. El seguimiento mostró una mejoría del cuadro inflamatorio y una leve recuperación de la agudeza visual, sin embargo, finalmente presentó un desprendimiento de retina con pérdida casi total de la visión unilateral. La NRA es una complicación infrecuente provocada por algunos virus herpes con mal pronóstico visual, desenlace que puede ser mejorado con un diagnóstico y tratamiento precoz con antivirales. El tratamiento prolongado permite evitar la recaída y el compromiso contralateral.
Abstract We present the case of a 63-year-old immunocompetent man with unilateral acute retinal necrosis (ARN). He consulted for blurred vision, eye pain, photophobia, and headache. Papillitis and peripheal chorioretinitis associated with vasculitis and peripheral retinal ischemia was confirmed. PCR from aqueous humor sample detected varicella zoster virus. The patient was treated with a combined therapy of oral corticosteroids, oral / intravenous acyclovir along with weekly intravitreous ganciclovir doses followed by oral valaciclovir for three months. A progressive decrease in viral load in aqueous humor was demonstrated during treatment. Follow-up showed improvement in the inflammatory condition and a slight recovery of visual acuity, however, finally he presented a retinal detachment with total loss of one-sided vision. ARN is an uncommon complication caused by some herpesviruses with a poor visual prognosis, an outcome that can be improved with early diagnosis and treatment using appropriate antivirals. Prolonged treatment reduces relapse frequency and fellow eye compromise.
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Humans , Male , Middle Aged , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Herpesvirus 3, Human/genetics , Antiviral Agents/therapeutic use , Acyclovir/therapeutic use , Polymerase Chain Reaction , Follow-Up StudiesABSTRACT
OBJECTIVE:To evaluate therapeutic efficacy and safety of valaciclovir versus acyclovir in the treatment of herpes zoster,and to provide evidence-based reference in clinic.METHODS:Retrieved from PubMed,Medline,CJFD,VIP and Wanfang Database,randomized controlled trials (RCTs) about valaciclovir (trial group) versus acyclovir (control group) in the treatment of herpes zoster were included.The data was analyzed statistically by using Rev Man 5.3 software after data extraction and quality evaluation by Cochrane systematic reviewer manual 5.1.0.RESULTS:A total of 12 RCTs were included,involving 1 059 patients.The result of Meta-analysis showed that:total response rate [OR =4.64,95 ％ CI (2.99,7.20),P＜ 0.001] and cure rate [OR =2.93,95％CI(2.13,4.03),P＜0.001] of trial group were significantly higher than those of control group;the incidence of postherpetic neuralgia in trial group [OR=0.39,95％CI(0.22,0.69),P=0.001] was significantly lower than control group,with statistical significance.There was no statistical significance in the incidence of ADR between 2 groups [OR=0.79,95％CI(0.49,1.29),P=0.35].CONCLUSIONS:Therapeutic efficacy of valaciclovir is better than that of acyclovir in the treatment of herpes zoster,can significantly reduce the incidence of postherpetic neuralgia.Both have similar safety.
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OBJECTIVE:To investigate the clinical efficacy and safety of high-dose valaciclovir combined with acupuncture in the treatment of herpes zoster. METHODS:194 patients with herpes zoster were divided into control group and observation group according to random number table method,with 97 cases in each group. Control group was given acupuncture treatment;observa-tion group was additionally given Valaciclovir hydrochlordide tablet 0.3 g,bid,based on control group. Both group received treat-ment for 10 d. Clinical efficacy and the time of clinical symptoms improvement were observed in 2 groups as well as VAS score and substance P level before and after treatment. The occurrence of postherpetic neuralgia and ADR were also observed in 2 groups. RESULTS:Total effective rate of observation group was 97.9%,which was significantly higher than 90.7% of control group,with statistical significance(P0.05);those of 2 groups were decreased sig-nificantly after treatment,and the observation group was lower than the control group,with statistical significance(P0.05). CONCLUSIONS:High-dose valacyclovir combined with acupuncture can effectively treat herpes zoster,with advantages of analge-sic effect,rapid lesions recovery,low rate of postherpetic neuralgia with good safety.
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OBJECTIVE: To investigate the moisture sorption properties of chemical reference substances (CRSs) by using dynamic vapor sorption (DVS) analysis technology in order to establish the distribution conditions, packaging materials, and usages of national chemical reference substances. METHODS: DVS analysis was adopted to acquire the moisture sorption dynamic profiles of five chemical reference substances of different moisture sorption types to evaluate their moisture sorption trend and capacities under different humidities. RESULTS: According to moisture sorption dynamics, we can found the hygroscopicity of disodium etidronate, sodium aminosalicylate, valaciclovir hydrochloride, aspirin and bosentan, and we have given advices about how to use these CRSs and what kind of bottles they should be packed in. CONCLUSION: DVS analysis can be used to record moisture sorption data in real time and visually observe water-CRS interactions under different humidities, which is an important technology for guiding the establishment and distribution of CRSs.
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OBJECTIVE: To establish a simple, sensitive method of high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) for the determination of valaciclovir in human plasma, and to evaluate the pharmacokinetics and bioequiva-lence of valaciclovir hydrochloride tablets in healthy volunteers. METHODS: A single oral dose of reference and test tables was given to 24 healthy male volunteers according to randomized crossover design. The plasma samples were precipitated by 30% trifluoroacetic acid, and the supernatant was neutralized by 50% ammonia and injected into the LC-MS/MS system directly. Then internal standard method was used to calculate the concentrations of valaciclovir in plasma. The pharmacokinetic parameters were calculated using SAS 9.1. RESULTS: The main pharmacokinetic parameters of valaciclovir test and reference preparations were as follows: ρmax (3457.92 ± 783.83) and(4181.25 ± 1130.19) μ · L-1, t1/2 (3.04 ± 0.41) and (3.13 ± 0.52) h, AUC0-tn(10 624.29 ± 2007.05) and (12 607. 30 ± 2 808.07) μg · h · L-1, respectively. F0-tn was (95.25 ± 15.72), and F0-∞ was (95.32 ± 15.76)%. CONCLUSION: The HPLC-MS/MS method established in this study is simple, sensitive and accurate, and it is suitable for the study of pharmacokinetics of valaciclovir in human plasma. The test tablets are bioequivalent to the reference tablets. Copyright 2012 by the Chinese Pharmaceutical Association.
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Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.
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Female , Humans , Acyclovir , Coma , Dyskinesias , Eating , Herpes Zoster , Herpesviridae Infections , Kidney Failure, Chronic , Neurotoxicity Syndromes , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Renal Dialysis , ValineABSTRACT
Dealing with varicella often causes doubts to general practitioners and pediatricians. In this article the author summaries guidelines based on solid evidence to treat varicella and prevent the disease in susceptible contacts in different clinical scenarios and presents his personal point of view in those controversial aspects commonly resolved by the authorized opinión of experts.
El manejo de la varicela despierta, con alta frecuencia, dudas en los médicos generales y pediatras. En este artículo, el autor resume aquellas recomendaciones basadas en sólida evidencia, para tratar la varicela y prevenir la enfermedad en los contactos susceptibles de un caso índice, en diferentes situaciones clínicas. Además emite su personal punto de vista en aquellos aspectos que despiertan controversia y comúnmente son resueltos en base a la opinión de reconocidos expertos.
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Humans , Chickenpox/therapy , Practice Guidelines as Topic , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Contact Tracing , Chickenpox/prevention & control , Chickenpox/transmission , Environmental Exposure , Evidence-Based Medicine , Risk Factors , Valine/analogs & derivatives , Valine/therapeutic useABSTRACT
Valaciclovir is L-valyl ester of acyclovir which has the antiviral effect against herpes zoster virus and Cytomegalovirus. Its adverse effects were reported as nephrotoxicity and neurotoxicity. Although the mechanism of nephrotoxicity of valaciclovir is indeterminate, several hypotheses such as obstructive uropathy and interstitial nephritis have been suggested. We experienced a 54-year-old female patient with IgA nephropathy who developed acute renal failure after taking valaciclovir. She did not develop either central neuropathy or respiratory muscle weakness. The serum creatinine was normalized after 6 days by withdrawal of valaciclovir and hydration. When we use valaciclovir in the elderly or patients with preexisting renal disease, we should monitor the renal function carefully.
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Aged , Female , Humans , Middle Aged , Acute Kidney Injury , Acyclovir , Creatinine , Cytomegalovirus , Glomerulonephritis, IGA , Herpesvirus 3, Human , Immunoglobulin A , Nephritis, Interstitial , Organothiophosphorus Compounds , Renal Insufficiency , Respiratory Muscles , ValineABSTRACT
Objective To explore the influence of the treatment and T-cell subsets in patients with recurrent genital herpes (RGH) by two treatment methods. Methods 64 cases of RGH patients were randomly divided int0 2 groups: 32 patients in the unite treatment group, the control group of 32 patients. Control group oral valaciclovir. The unite treatment group of oral valaciclovir tablets, in addition, also accepted mycobacterium phle injection treatment. All the patients before and after treatment were analyzed by flow cytometry using T-cell subsets. Results In the unite treatment group after treatment RGH relapse frequency [(1.01±0.79)] than that of the control group [(2.53±0.93)] was significantly decreased (P<0.001). In the unite treatment group after treatment CD+4 T cells and CDCD+4/CDCD+8 ratio than the control group were significantly increased (P<0.05), CD+8 cells compared with the control group was significantly decreased (P<0.05). Conclusion The cellular immunity is abnormal in RGH patients and it plays an important role in pathogenesis of RGH. Mycobacterium phle may enhance cellular immunity of the patients and these patients treated with it showed some better effects.
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Medical prescription errors are frequent in community settings and information exploring its magnitude during antiviral treatment of herpes zoster is scarce. A questionnaire was applied to 31 physicians working in hospital- or community-based settings in Santiago, Chile in order to characterize their dosing and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was more often prescribed than valaciclovir (71.9 and 28.1 percent, respectively), but less than a third of prescription (27.3 percent) fulfilled the minimal aciclovir dosing and timing criteria for clinical efficacy (4 gr per day and < 72 hours since rash initiaton). The limited size of the simple prevented exploring factors linked to a misleading prescription. Appropriate knowledge on dosing and timing of aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of physicians working in various clinical settings in Chile.
Los errores en la prescripción de medicamentos son frecuentes en escenarios ambulatorios y no hay información disponible sobre el uso de antivirales en el tratamiento del herpes zoster. Para conocer la dosis y oportunidad en la prescripción de aciclovir o valaciclovir se aplicó un cuestionario a 31 médicos que trabajan en hospitales o sitios de atención primaria en Santiago y que declararon haber atendido este tipo de pacientes. El compuesto aciclovir fue más indicado que valaciclovir (71,9 vs 28,1 por ciento) pero menos de un tercio de las prescripciones (27,3 por ciento) cumplieron simultáneamente con una dosis mínima (4 g/día) y ventanas de tiempo apropiadas de aciclovir (hasta 72 horas del rash). El reducido tamaño de la muestra impidió efectuar un análisis de los factores ligados a este fenómeno. El conocimiento apropiado sobre dosis y oportunidad de aciclovir o valaciclovir fue infrecuente en un grupo de médicos que declararon atender pacientes con herpes zoster en Santiago.
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Adult , Female , Humans , Male , Middle Aged , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Herpes Zoster/drug therapy , Medication Errors/statistics & numerical data , Valine/analogs & derivatives , Acyclovir/administration & dosage , Surveys and Questionnaires , Valine/administration & dosage , Valine/therapeutic useABSTRACT
OBJECTIVE:To study the pharmacokinetics and relative bioavailability of two kinds of preparations of valaciclovir hydrochloride.METHODS:This was a randomized two-way cross-over study.A total of 18 healthy volunteers were randomly assigned to receive single oral dose of test valaciclovir tablets(trial group) or reference valaciclovir tablets(control group),with the plasma aciclovir concentrations determined by HPLC,the pharmacokinetics parameters calculated and the relative bioavailability evaluated using 3p97 program.RESULTS:The main pharmacokinetic parameters test and reference valaciclovir hydrochloride tablets were as follows:AUC0～ 24:(12.85? 4.32) vs.(12.19? 4.63) ?g? h? mL-1;AUC0～ ∞:(14.65? 5.75) vs.(13.27? 5.03) ?g? h? mL-1;Cmax:(3.55? 0.92) vs.(3.71? 0.97) ?g? mL-1;tmax:(1.44? 0.43) h vs.(1.33? 0.37) h;t1/2:(6.23? 2.81) h and(4.55? 1.84) h.The relative bioavailability of the test valaciclovir tablets were(111.01? 23.52) %.CONCLUSION:The reference valaciclovir tablets and the test valaciclovir tablets were bioequivalent.
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OBJECTIVE:To compare the pharmacoeconomic effectiveness of three antiviral agents for herpes zoster ME_THODS:101 patients with herpes zoster were divided into three groups who received acyclovir injection,valaciclovir tablet and ribavirin injection,respectively Evaluation was carried out with cost-effectiveness analysis RESULTS:The cost-effectiveness ratios of three groups were $1 288 2,$863 0 and $949 8 CONCLUSION:Valaciclovir was the best antiviral agents for herpes zoster
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0 05) CONCLUSION:The two products of valaciclovir tablet are bioequivalent
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OBJECTIVE:To investigate the preparation technic and method of quality control of Xinyoukexing tincture(XYKX) METHODS:To determine the content of Valaciclovir by spectrophotography,and podophyllotoxin by dual-wavelength spectrophotography RESULTS:In the range of 14 88～34 72?g/ml,the Valaciclovir concentration in XYKX was in direct proportion to the absorption at 310 4nm,C=44 5 905A+1 7 556,r=0 9 998 In the range of 17 50～50 12?g/ml,the podophyllotoxin concentration in XYKX was in direct proportion to the absorption at 292nm,C=97 7 981Ap292+1 3 614,r=0 9 999,AP292=As292-As325 CONCLUSION:The preparation technic of XYKX is simple and the method of quality control is feasible
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OBJECTIVE: To study pharmacokinetics of valaciclovir hydrochloride tablets and to evaluate the bioequivalence of test and reference tablets. METHODS: In a two-period cross-over design test, 18 healthy volunteers were given a single oral dose of 600 mg test valaciclovir hydrochloride and 600 mg reference formulations respectively. Plasma concentrations of acyclovir were determined by HPLC method. The pharmacokinetic parameters of the two formulations were calculated and analyzed statistically. RESULTS: The main pharmacokinetic parameters of test vs. reference valacyclovir hydrochloride tablets were as follows:tmax(1.69?0.25)h vs. (1.72?0.26)h, Cmax(3.34?0.58) ?g?mL-1 vs. (3.40?0.49)?g?mL-1, t1/2(2.73?0.31)h vs. (2.97?0.33)h, AUC0～14(11.22?2.21) ?g?h?mL-1 vs. (11.12?1.90)?g?h?mL-1, AUC0～∞(11.76?2.15) ?g?h?mL-1 vs. (11.61?1.86)?g?h?mL-1, respectively. As compared with reference formulation, the relative bioavailability of test formulation was (101.06?11.72)%. CONCLUSION: The two preparations are bioequivalent.
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0.05).The bioequivalence of test tablets was (105.7?13.9)%.CONCLUSION:The results of statistics analysis show that the test and reference tablets were bioequivalent.