Nausea and Vomiting Possibly Associated with Intravenous Acyclovir

Abstract

Nausea and vomiting have not been clearly associated with parenteral acyclovir. We report a pediatric patient who developed nausea and vomiting apparently associated with intravenous acyclovir therapy. The child received acyclovir (1500 mg/m²/d) for treatment of recurrent varicella zoster with possible dissemination. Nausea and vomiting could be attributed only to acyclovir therapy. Discontinuing the drug resulted in a resolution of the adverse symptoms. Adverse effects of parenteral acyclovir can mimic the early manifestations of Reye's syndrome, which is an important consideration in children with viral infections. It is necessary to distinguish the cause of nausea and vomiting for proper management of patients.

Nausea and vomiting are important side effects of parenteral acyclovir that have not been reported in children. These side effects are of special concern in the pediatric population because they can mimic the early clinical manifestations of Reye's syndrome. It is necessary to distinguish the cause of these symptoms in order to institute proper measures. Nausea and vomiting may be related to the hydration status of the patient during acyclovir therapy. Maintenance intravenous therapy or assurance of good oral intake may help in reducing this side effect. Evaluation of the relationship between nausea and vomiting and acyclovir therapy is needed in a prospective study involving a large number of patients so that therapy with this drug can be optimized.