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European Journal of Clinical Pharmacology

, Volume 75, Issue 2, pp 287–288 | Cite as

No alteration of voriconazole concentration by plasmapheresis in a critically ill patient

  • Manuela Vay
  • Kathrin I. Foerster
  • Mazyar Mahmoudi
  • Jessica Seeßle
  • Gerd MikusEmail author
Letter to the Editor

Invasive pulmonary aspergillosis is a life-threatening disease with a mortality rate of 60–90% [1], if untreated. Patients with strongly suspected invasive aspergillosis should be treated with voriconazole immediately [2]. Due to its narrow therapeutic index, voriconazole therapeutic drug monitoring is often applied [3] (trough concentration > 1.5 μg/mL for efficacy but < 5–6 μg/mL to reduce toxicity [4]). A procedure like plasmapheresis may alter plasma concentrations and could decrease efficacy of voriconazole. Plasmapheresis affected significantly plasma concentrations of drugs (e.g. vancomycin, teicoplanin, verapamil [5]), resulting in subtherapeutic concentrations [5, 6]. However, plasmapheresis is a rarely used treatment and only limited data is available about the necessity of voriconazole dose adjustment [7].

A 66-year-old female patient (71 kg) with acute renal failure caused by recently diagnosed granulomatosis with polyangiitis required plasma exchange therapy. Her clinical...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent of the patient

Informed consent of the patient was obtained.

References

  1. 1.
    Bassetti M, Righi E, De Pascale G, De Gaudio R, Giarratano A, Mazzei T, Morace G, Petrosillo N, Stefani S, Antonelli M (2014) How to manage aspergillosis in non-neutropenic intensive care unit patients. Crit Care 18(4):458.  https://doi.org/10.1186/s13054-014-0458-4 CrossRefGoogle Scholar
  2. 2.
    Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JA, Bennett JE (2016) Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 63(4):e1–e60.  https://doi.org/10.1093/cid/ciw326 CrossRefGoogle Scholar
  3. 3.
    Theuretzbacher U, Ihle F, Derendorf H (2006) Pharmacokinetic/pharmacodynamic profile of voriconazole. Clin Pharmacokinet 45(7):649–663.  https://doi.org/10.2165/00003088-200645070-00002 CrossRefGoogle Scholar
  4. 4.
    Pascual A, Csajka C, Buclin T, Bolay S, Bille J, Calandra T, Marchetti O (2012) Challenging recommended oral and intravenous voriconazole doses for improved efficacy and safety: population pharmacokinetics-based analysis of adult patients with invasive fungal infections. Clin Infect Dis 55(3):381–390.  https://doi.org/10.1093/cid/cis437 CrossRefGoogle Scholar
  5. 5.
    Ibrahim RB, Liu C, Cronin SM, Murphy BC, Cha R, Swerdlow P, Edwards DJ (2007) Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy 27(11):1529–1549.  https://doi.org/10.1592/phco.27.11.1529 CrossRefGoogle Scholar
  6. 6.
    Kintzel PE, Eastlund T, Calis KA (2003) Extracorporeal removal of antimicrobials during plasmapheresis. J Clin Apher 18(4):194–205.  https://doi.org/10.1002/jca.10074 CrossRefGoogle Scholar
  7. 7.
    Spriet I, Bruggemann RJ, Annaert P, Meersseman P, Van Wijngaerden E, Lagrou K, Willems L (2013) Pharmacokinetic profile of voriconazole in a critically ill patient on therapeutic plasma exchange. Ther Drug Monit 35(1):141–143.  https://doi.org/10.1097/FTD.0b013e31827d76b0 CrossRefGoogle Scholar
  8. 8.
    Pfizer Vfend: Summary of product characteristics. state of information: January 2017 https://www.fachinfo.de/pdf/015292 (accessed 08/2018)
  9. 9.
    Vanstraelen K, Wauters J, De Loor H, Vercammen I, Annaert P, Lagrou K, Spriet I (2014) Protein-binding characteristics of voriconazole determined by high-throughput equilibrium dialysis. J Pharm Sci 103(8):2565–2570.  https://doi.org/10.1002/jps.24064 CrossRefGoogle Scholar
  10. 10.
    Preston C Stockley’s drug interactions [online]. In: ed Pharmaceutical Press www.medicinescomplete.com (accessed 08/2018)

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of Gastroenterology, Infectious Diseases, IntoxicationHeidelberg University HospitalHeidelbergGermany

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