Medications in Patients Treated With Therapeutic Plasma Exchange: Prescription Dosage, Timing, and Drug Overdose

Abstract

Therapeutic plasma exchange (TPE) is an extracorporeal process commonly used in clinical medicine for the treatment of a variety of neurological, renal, hematological, dermatological, and other diseases. Inherent to the procedure, patients' plasma removal may lead to the extraction of drugs they are concurrently receiving. This review discusses the published literature assessing TPE's influence on different drug classes' disposition and, when applicable, sets forth management recommendations in cases where the drugs are used at the usual doses and in cases of drug overdose.

Hemostasis management and therapeutic plasma exchange: Results of a practice survey

“…The procedure may remove the anticoagulant medications as well as the specific anticoagulant targets. There is limited information on medication removal with TPE, but several factors influence this including protein binding, volume of distribution, dose, timing since last dose; volume of TPE, length of the TPE procedure, successive TPE procedures, and potentially the replacement fluid . Further investigation is needed to establish the best practice with regard to anticoagulants and antiplatelet therapy in the setting of TPE.…”

Weathering the storm: A case of thyroid storm refractory to conventional treatment benefiting from therapeutic plasma exchange

“…These cases suggest that the benefit of TPE may be due to a reduction in plasma concentrations of amiodarone. However, despite being highly bound to plasma proteins (>98%), amiodarone has a large volume of distribution (5000 L) and demonstrates extensive equilibration from peripheral tissues, rendering TPE ineffective at removing this medication . Furthermore, the median time for amiodarone‐induced thyrotoxicosis to manifest is generally following months, and even years, of exposure .…”

Utilization of plasmapheresis for organophosphate intoxication: A case report

“…Plasmapheresis is effective in elimination of substances with high plasma protein binding capacity (>80%) and low distribution volume (<0.2 L/kg bw) 1, 6, 7. There are several reports indicating effectiveness of plasmapheresis in different poisonings like amitriptyline, phalloid mushroom, propranolol, amlodipine, diltiazem, verapamil, carbamazepine, theophylline, l -thyroxine, and heavy metals like mercury 7 . It is the protein binding capacity of those drugs/substances which make sense to use plasmapheresis for reducing plasma levels, and poisoning symptoms as well.…”