Liver damage from Acyclovir

[Phoenixx]

I read several times that Acyclovir can damage the liver in high doses or during long-term usage. Only the latter is interesting in my case. Is that even possible in low doses that are recommended usually for suppression? Or does that only happen in high dose regimes / otherwise liver damaged people (alcoholics, people taking other meds as well)? What would be the critical amount usually?

[floydmonk]

I'm not aware of any specific cases, but I feel I might be uniquely qualified to speak on this subject. I have had a fatty liver for about five years, escalating to about 10 months ago where I discovered the root of my problems was the fatty liver. I had/have daily right quadrant pain associated with poor diet and obesity. Interestingly, my initial herpes infection occurred just a few months before this, lending a lot of credit to the weakened immune system theory. I do not take acyclovir daily, as the doctors refused to provide it to me absent recurring symptoms. When I had it, I was prescribed 400mg, but later took up to 800mg at once without any negative effects. I instead use some special supplements which I believe help with the nerve pain and keep the virus at bay.

I'm aware anything taken daily can be hard on your liver. It is important to flush your system out regularly (liver and digestive tract) if you are taking any medicine on a daily basis. By flush, I mean stop taking all medication for a couple of days (within reason, e.g. for heart medication you can't do this), and switch to a healthier diet, drink water, and fast for 6-8 hours a day. I would recommend this once every 3-6 months at minimum. This will give your liver some time to purge the toxins and foreign compounds which tend to build up when taking a daily regiment. There's also products out there for "liver flushing" or milk thistle. I've recently learned about something called TUDCA, which body builders use to flush hormones and steroids out of their livers. I also recommend fiber supplements as they absorb so much from your body and help carry out toxins. I've been studying liver health extensively for nearly a year, so there's my two cents on it.

I have lost a lot of weight after changing diet and taking certain supplements, I don't experience pain every day now and I'm reducing the fat in my liver. I want to take daily acyclovir, but it's not worth the potential liver effects in my case. Maybe in a few years when I'm healthier.

Edited July 20, 2019 by floydmonk

[Phoenixx]

Thank you for the sophisticated reply. Good to know that you had no noticable negative effects from Acyclovir despite the fatty liver.

I read that milk thistle can cause diarrhea and other stomach problems. Certainly not helpful in my case. TUDCA I've never heard of. But nice to know that there is something in case my liver makes problems one day.

Fasting for 6-8 hours a day is also what people do in the interval weight loss diet. A welcomed side effect of the liver flushing then.

Not taking any Acyclovir for a week would probably be the hardest part for me because that would almost certainly provoke an outbreak. But maybe taking an occasional pill every 2 days or something for a week is enough to let the body recover.

I regularly drink a lot of water (or let's say I drink the recommended amount which is certainly higher than what people drink on average) and eat good fibre daily (flax seed, chia seed). That's gonna protect my quite a bit already I suppose. If I didn't do it I'd suffer from constipation and/or diarrhea anyway.

At least I am not in my twenties anymore and drink far less alcohol than before which would usually be the biggest liver damaging factor these days. It would have been a lot harder for me before with all the parties and social pressure to drink.

I read what the U.S. National Institutes of Health write about the Hepatotoxicity of Acyclovir. It's quite encouraging for us and goes along with your experiences since we only take it orally and not intravenously. Even the latter is not confirmed to be harmful:

"Despite widespread use, there is little evidence that acyclovir when given orally causes significant liver injury.  Serum enzyme levels generally do not change during oral acyclovir therapy.  High dose intravenous administration of acyclovir is associated with renal dysfunction and thrombocytopenia, and occasionally with transient mild-to-moderate elevations in serum ALT levels, which have been asymptomatic and self-limited.  There have rare instances of acute, clinically apparent liver injury reported that were attributed to acyclovir or valacyclovir (a prodrug of acyclovir with better oral absorption), but these have not been particularly convincing.  Some degree of liver injury and even jaundice can occur during the course of herpes simplex or varicella zoster infection, and these complications could be mistaken for drug induced liver injury.  Furthermore, in the reported cases, patients were receiving other medications and had other unlying comorbidities that may have been responsible for the liver injury."