title: Pharmacokinetic profile of voriconazole in a critically ill patient on therapeutic plasma exchange.
abstract: BACKGROUND
  Extracorporeal removal of drugs during therapeutic plasma exchange (TPE) can lead to decreased efficacy, as shown in several reports discussing altered pharmacokinetics (PKs) of antibiotics during TPE. In particular, drugs with a low volume of distribution or a high protein binding are susceptible to extracorporeal removal, as these drugs remain substantially within the intravascular space. No information is known about antifungal drug removal during TPE. We report the PKs of voriconazole in a critically ill patient undergoing TPE.
  
  
  METHODS
  A 61-year-old man, presenting with catastrophic antiphospholipid syndrome for which TPE was started, developed probable pulmonary invasive aspergillosis. Intravenous voriconazole was started. Blood samples were taken under steady state conditions to calculate PK parameters of voriconazole, both with and without TPE.
  
  
  RESULTS
  PK parameters (area under the curve, Cl, Vd, and t1/2) were equivalent on both days. Voriconazole has a distribution volume of 4.5 L/kg and a protein binding of 58%, suggesting that drug removal during TPE would not be clinically significant. Our data support this assumption.
  
  
  CONCLUSIONS
  Based on our findings, it seems that TPE does not alter the PK behavior of voriconazole. Voriconazole dosages should not be adjusted during TPE.
authors.affiliation: Department of Pharmacy, 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: Roger J M
authors.initials: RJ
authors.lastname: Brüggemann
authors.forename: Pieter
authors.initials: P
authors.lastname: Annaert
authors.forename: Philippe
authors.initials: P
authors.lastname: Meersseman
authors.forename: Eric
authors.initials: E
authors.lastname: Van Wijngaerden
authors.forename: Katrien
authors.initials: K
authors.lastname: Lagrou
authors.forename: Ludo
authors.initials: L
authors.lastname: Willems
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000188:drug therapy / Q000378:metabolism; D016638:Critical Illness; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods; D010956:Plasmapheresis / Q000379:methods; D011743:Pyrimidines / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D014230:Triazoles / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole