Evaluation of sulfobutylether-尾-cyclodextrin (SBECD) accumulation and voriconazole pharmacokinetics in critically ill patients undergoing continuous renal replacement therapy
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- 作者：Tyree H Kiser (1)
Douglas N Fish (1)
Christina L Aquilante (2)
Joseph E Rower (2)
Michael F Wempe (2)
Robert MacLaren (1)
Isaac Teitelbaum (3)
1. Department of Clinical Pharmacy ; University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences ; 12850 E Montview Blvd ; Mail Stop C238 ; Aurora ; CO ; 80045 ; USA
2. Department of Pharmaceutical Sciences ; University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences ; 12850 E Montview Blvd ; Mail Stop C238 ; Aurora ; CO ; 80045 ; USA
3. Department of Medicine ; University of Colorado Anschutz Medical Campus ; 12605 E 16th Ave ; Box F774 ; Aurora ; CO ; 80045 ; USA - 刊名：Critical Care
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：19
- 期：1
- 全文大小：839 KB
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- 出版者：BioMed Central
- ISSN：1364-8535
文摘
Introduction Intravenous (IV) voriconazole is not recommended in patients with creatinine clearance Methods This prospective, open-label pharmacokinetic study enrolled patients >18聽years old receiving IV voriconazole for a known or suspected invasive fungal infection while undergoing CRRT. Serial blood and effluent samples were collected on days 1, 3, 5, 7, and every 3 to 5聽days thereafter. SBECD, voriconazole, and voriconazole N-oxide plasma and effluent concentrations were measured by liquid chromatography-tandem mass spectrometry. Pharmacokinetic, pharmacodynamic, and pharmacogenetic analyses were conducted. Results Ten patients (mean鈥壜扁€塻tandard deviation (SD)) 53鈥壜扁€?1聽years old, 50% male, 81鈥壜扁€?4聽kg, with Acute Physiologic and Chronic Health Evaluation II (APACHE II) scores of 31.5鈥壜扁€?.8 were evaluated. All patients underwent continuous venovenous hemofiltration (CVVH) with a median predilution replacement fluid rate of 36 (interquartile range (IQR) 32 to 37) ml/kg/hr and total ultrafiltration rate of 38 (IQR 34 to 39) ml/kg/hr. Mean鈥壜扁€塖D voriconazole and SBECD dosages administered were 8.1鈥壜扁€?.1聽mg/kg/day and 129鈥壜扁€?3聽mg/kg/day, respectively. Voriconazole plasma trough concentrations were >1聽mg/L in all patients with CVVH accounting for only 15% of the total body clearance. CVVH accounted for 86% of the total body clearance of SBECD with the majority of the dose being recovered in the effluent. Minimal increases in dose normalized SBECD area under the concentration-time curve from 0 to 12聽hours (AUC0-12) (4,484鈥壜扁€?,368 to 4,553鈥壜扁€?,880聽mg*hr/L; P鈥?鈥?.97) were observed after study day 1. Conclusions CVVH effectively removed SBECD at a rate similar to the ultrafiltration rate. Voriconazole clearance by CVVH was not clinically significant. Standard dosages of IV voriconazole can be utilized in patients undergoing CVVH without significant risk of SBECD accumulation. Trial registration ClinicalTrials.gov NCT01101386. Registered 6 April 2010.