Pharmacokinetics of intraperitoneal fluconazole during continuous cycling peritoneal dialysis.
OBJECTIVE
To investigate the pharmacokinetic characteristics of intraperitoneal fluconazole in patients undergoing continuous cycling peritoneal dialysis (CCPD).


METHODS
Prospective, nonrandomized, single-dose, open-label study.


METHODS
Five noninfected volunteer CCPD patients.


METHODS
Patients received a single dose of intraperitoneal fluconazole 200 mg during their long daytime dwell. Blood samples were collected before and 1, 3, 6, 12 (end of first dwell), 24 (after overnight cycling), 48, 72, 96, and 120 hours after dosing. Used dialysate was collected throughout the study. Unless the patient was anuric, urine was collected for the first 48 hours.


METHODS
Fluconazole concentrations were assayed by gas-liquid chromatography. Pharmacokinetic parameters were calculated using standard noncompartmental techniques.


RESULTS
The bioavailability of intraperitoneal fluconazole was 96% +/- 2% over a 12-hour dwell, absorption half-life was 2.5 +/- 1.2 hours, serum elimination half-life was 71.65 +/- 12.76 hours, and volume of distribution was 0.66 +/- 0.13 L/kg. Peritoneal clearance was 5.96 +/- 0.93 mL/min and proportional to total dialysate volume. Renal clearance was proportional to renal creatinine clearance.


CONCLUSIONS
Current treatment guidelines for fungal peritonitis suggest fluconazole 200 mg intraperitoneally every 24 hours. Our data suggest that this dose, administered every 48 hours, is more than sufficient to maintain serum and peritoneal concentrations above the minimum inhibitory concentration for most Candida spp. Other factors, such as residual renal function and dialysis prescription, may also need to be considered.
Dahl
N V
NV
College of Pharmacy, Rutgers, State University of New Jersey, Piscataway 09954, USA.
Foote
E F
EF
Searson
K M
KM
Fein
J L
JL
Kapoian
T
T
Steward
C A
CA
Sherman
R A
RA
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D019540:Area Under Curve; D002849:Chromatography, Gas; D015314:Dialysis Solutions / Q000032:analysis; D005260:Female; D015725:Fluconazole / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D006207:Half-Life; D006801:Humans; D007263:Infusions, Parenteral; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies
D000935:Antifungal Agents; D015314:Dialysis Solutions; D015725:Fluconazole