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Decreasing Voriconazole Requirement in a Patient After Extracorporeal Membrane Oxygenation Discontinuation: A Case Report.

Authors
  • Peterson, Eric L1, 2, 3
  • Chittick, Paul J4, 5
  • Richardson, Chad L1
  • 1 Beaumont Hospital, Department of Pharmacy, Royal Oak, MI, USA, 48073.
  • 2 Children's Hospital Colorado, Aurora, CO, USA, 80023.
  • 3 Children's Hospital Colorado, Department of Pharmacy, Aurora, CO, USA.
  • 4 Beaumont Hospital, Department of Infectious Diseases, Royal Oak, MI, USA, 48073.
  • 5 Oakland University William Beaumont School of Medicine, Rochester, MI, USA, 48309.
Type
Published Article
Journal
Transplant Infectious Disease
Publisher
Wiley (Blackwell Publishing)
Publication Date
Dec 14, 2020
Identifiers
DOI: 10.1111/tid.13545
PMID: 33316840
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Patients receiving extracorporeal membrane oxygenation (ECMO) may display large decreases in drug concentrations due to increases in volume of distribution and drug binding to ECMO circuits, tubing, oxygenator and coating materials. We report a case of a critically-ill male who was 10 months status post deceased donor renal transplant being treated with voriconazole for suspected Aspergillosis. Initially, multiple dose increases, up to 11.3mg/kg/dose, were required while on ECMO therapy to obtain goal voriconazole trough concentrations between 2 - 5.5 mcg/ml. The patient's voriconazole dose requirement subsequently decreased to 7.3 mg/kg/dose after ECMO discontinuation, which represented a 45% reduction in voriconazole dose requirement. Based upon this experience, voriconazole appears to bind to artificial surfaces on ECMO devices. In addition to close monitoring of trough levels, it may be appropriate to empirically reduce the voriconazole dose in patients after ECMO discontinuation. This article is protected by copyright. All rights reserved.

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