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Aciclovir dose adjustment in CKD — GPhC CRA MCQ

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HardRenal Dose AdjustmentAciclovir dose adjustment in CKDGPhC CRA

A 73-year-old woman in a care home presents with shingles affecting the left T5 dermatome. The rash appeared two days ago. She has a past medical history of chronic kidney disease (eGFR 25 mL/min/1.73m2). Her GP prescribes aciclovir. What dose adjustment is required?

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Correct answer: E — The dose of aciclovir should be reduced and/or the dosing interval extended according to the level of renal impairment

Aciclovir is renally excreted and accumulation can occur in renal impairment, increasing the risk of neurological side effects. The BNF provides specific dose reduction guidance based on creatinine clearance. For an eGFR of 25 mL/min, the dose and/or dosing interval should be adjusted. Aciclovir is not absolutely contraindicated but does require careful dose modification. Valaciclovir also requires dose adjustment in renal impairment.

Reference: BNF; NICE CKS Shingles