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We report an elderly woman with stage 5 chronic kidney disease who developed neurotoxicity after being prescribed unadjusted doses of valacyclovir and provide measurements of the amount of the drug eliminated through haemodialysis <jats:italic>vs<\/jats:italic>. native renal clearance. The patient's estimated body\u2010burden of drug before the first session of dialysis was estimated at 580.3\u00a0mg. During the first haemodialysis session acyclovir plasma concentrations decreased from 8.8 to 3.2\u00a0mg\/L (63.6%). Her body\u2010burden of drug before the second session of haemodialysis was estimated as 131.9\u00a0mg. During the 2.5\u00a0h of the second dialysis session a total of 66.6\u00a0mg was eliminated based on measured dialysate concentrations. Urinary elimination was 17.7\u00a0mg over 30\u2009h. Despite minimal urinary elimination her blood concentration fell from 8.8 to 0.88\u2009mg\/L with a total of 4.5\u00a0h of haemodialysis. Haemodialysis appears to be an effective method of eliminating acyclovir, especially in patients with advanced kidney disease.<\/jats:p>","DOI":"10.1002\/bcp.70138","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T06:24:26Z","timestamp":1749795866000},"page":"2469-2473","source":"Crossref","is-referenced-by-count":1,"title":["Neurotoxicity from inordinate valacyclovir dosage in an elderly woman with stage 5 chronic kidney disease"],"prefix":"10.1002","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4679-3504","authenticated-orcid":false,"given":"Juan A.","family":"Vasquez Vasquez","sequence":"first","affiliation":[{"name":"NYU Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle D.","family":"Pires","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Ronald O. 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