title: The impact of a transjugular intrahepatic portosystemic shunt on the pharmacokinetics of caspofungin in a critically ill patient.
abstract: BACKGROUND
  Caspofungin is the first echinocandin approved for the treatment of invasive fungal infections (IFI). As it is also well tolerated in patients with liver cirrhosis, caspofungin is an alternative for azoles in the treatment of IFI in patients with hepatic insufficiency.
  
  
  METHODS
  We report, for the first time, the pharmacokinetics (PK) of caspofungin in a patient with Child A cirrhosis and a transjugular intrahepatic portosystemic shunt (TIPS) and compare values to previously published results.
  
  
  RESULTS
  Caspofungin plasma levels were determined on days 14 (before TIPS reduction) and 29 (after TIPS reduction) of treatment. Troughs and peaks were 3.55 and 3.34 mg/l on day 14 and 9.28 and 9.49 mg/l on day 29, resulting in, (1) PK parameters only slightly higher than previously reported results in healthy volunteers and patients with Child A liver cirrhosis without TIPS and (2) similar exposures before versus after TIPS reduction. This limited increase in exposure is not expected to be correlated to toxicity.
  
  
  CONCLUSIONS
  Caspofungin is a safe alternative for azoles when treating patients with TIPS suffering from IFI.
authors.affiliation: Pharmacy Department, Research Centre for Clinical Pharmacy, University Hospitals Leuven, Leuven, Belgium. isabel.spriet@uzleuven.be
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
authors.forename: Geert
authors.initials: G
authors.lastname: Meyfroidt
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.forename: Ludo
authors.initials: L
authors.lastname: Willems
mesh_terms: D000935:Antifungal Agents / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000378:metabolism; D000077336:Caspofungin; D016638:Critical Illness; D054714:Echinocandins / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006801:Humans; D055666:Lipopeptides; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin