title: The effect of veno-venous ECMO on the pharmacokinetics of Ritonavir, Darunavir, Tenofovir and Lamivudine.
abstract: To our knowledge, there is no published data on the pharmacokinetic (PK) profile of antiretroviral (ART) drugs on patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. We present PK analyses of Ritonavir, Darunavir, Lamivudine and Tenofovir in a patient with HIV who required veno-venous ECMO (VV ECMO).
  
  
  
  Plasma concentrations for Ritonavir, Darunavir, Tenofovir and Lamivudine were obtained while the patient was on ECMO following pre-emptive dose adjustments. Published population PK models were used to simulate plasma concentration profiles for the drugs. The population prediction and the observed plasma concentrations were then overlaid with the expected drug profiles using the individual Bayesian post-hoc parameter estimates.
  
  
  
  Following dose adjustments, the PK profiles of Ritonavir, Darunavir and Tenofovir fell within the expected range and appeared similar to the population prediction, although slightly different for Ritonavir. The observed data for Lamivudine and its PK profile were completely different from the data available in the literature.
  
  
  
  To our knowledge, this is the first study reporting the PK profile of ART drugs during ECMO therapy. Based on our results, dose adjustment of ART drugs while on VV ECMO may be advisable. Further study of the PK profile of Lamivudine is required.
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom. Electronic address: mzyvmas@yahoo.co.uk.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Ghazi Suliman
authors.affiliation: Manchester Pharmacy School, The University of Manchester, Manchester M13 9PT, United Kingdom.
authors.forename: Kayode
authors.initials: K
authors.lastname: Ogungbenro
authors.affiliation: The Infectious Diseases Unit, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Christos
authors.initials: C
authors.lastname: Kosmidis
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Ashworth
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Julian
authors.initials: J
authors.lastname: Barker
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Anita
authors.initials: A
authors.lastname: Szabo-Barnes
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Lee
authors.initials: L
authors.lastname: Feddy
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Igor
authors.initials: I
authors.lastname: Fedor
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Hayes
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stirling
authors.affiliation: The North West Heart and Lung Centre, The University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Malagon
mesh_terms: D001499:Bayes Theorem; D000069454:Darunavir / Q000097:blood / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D015199:Extracorporeal Membrane Oxygenation; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000097:blood / Q000493:pharmacokinetics*; D006801:Humans; D019259:Lamivudine / Q000097:blood / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D019438:Ritonavir / Q000097:blood / Q000493:pharmacokinetics; D000068698:Tenofovir / Q000097:blood / Q000493:pharmacokinetics
chemical_list: D017320:HIV Protease Inhibitors; D019259:Lamivudine; D000068698:Tenofovir; D019438:Ritonavir; D000069454:Darunavir
keywords: ARTs; ECMO; Extracorporeal membrane oxygenation; PK; VV ECMO; antiretrovirals; pharmacokinetics; veno-venous extracorporeal membrane oxygenation