Moderate
Probable
설명
Concurrent use of acyclovir and cyclosporine can increase nephrotoxicity risk, as both agents are renally cleared and individually nephrotoxic.
기전
Acyclovir causes crystalline nephropathy through renal tubular precipitation at high doses; cyclosporine independently causes afferent arteriolar vasoconstriction; combined renal insult is additive.
임상적 중요성
Case series in transplant recipients show elevated serum creatinine during acyclovir prophylaxis with cyclosporine; both drugs also compete for renal tubular secretion via OAT transporters.
관리 방법
Ensure adequate hydration during IV acyclovir; monitor serum creatinine and cyclosporine trough levels; consider dose reduction of acyclovir in renal impairment.