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Overdoses involving ingestion of up to 20 g have been reported. Clinical features of aciclovir overdose include agitation, coma, seizures, and lethargy. Precipitation of acyclovir crystals in the renal tubules which may cause renal dysfunction leading to renal failure and anuria have been observed when renal concentrations of aciclovir exceed 2.5 mg/mL.
Management: Patients should be observed closely for signs of toxicity. Hemodialysis significantly enhances the removal of aciclovir from the blood and may, therefore, be considered a management option in the event of symptomatic overdose.
