Potential voriconazole and caspofungin sequestration during extracorporeal membrane oxygenation

Pharmacokinetics of Caspofungin in Critically Ill Patients on Continuous Renal Replacement Therapy

“…However, details of extracorporeal procedures, particularly the material of the applied membranes, might have a considerable impact on drug elimination. Thus, striking differences in caspofungin levels were reported in two patients undergoing different modes of extracorporeal membrane oxygenation (4,5). The different extracorporeal clearances that we obtained by estimation from C in Ϫ C out and from S c suggest some absorption of caspofungin by the hemofilter membrane, which, however, had no detectable effect on caspofungin plasma pharmacokinetics.…”

“…xtracorporeal devices can exert hardly predictable effects on drug disposition (1)(2)(3)(4)(5). The echinocandin caspofungin (molecular mass, 1,093 Da) is licensed for treatment of invasive candidiasis, for empirical therapy of persistent fever during neutropenia, and for salvage therapy of invasive aspergillosis (6,7).…”

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

“…Mehta et al [41] reporting a 71% loss of voriconazole in the circuit, which is highly relevant because of the association between voriconazole trough blood levels and outcome. A problem of this circuit loss may be the circuit saturation that occurs with time, meaning that the initial high doses should be later decreased to avoid drug toxicity [70,72,81]. TDM of voriconazole is suggested to guide this dosing.…”

“…Unfortunately, PK data in adult patients on ECMO are sparse. Neonatal and animal studies are available but have shown significant variability and unpredictability of antibiotic PK during ECMO [32,35,46,50,[66][67][68][69][70][71][72][73][74][75][76][77][78][79] (Table 1). However, no dosing guidelines exist for this group of patients.…”

Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review

“…The third patient had inadequate or undetectable serum concentrations but this patient was also receiving continuous venovenous hemodiafiltration (CVVHDF) [84]. [86].…”