Impact of extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration on the pharmacokinetics of oseltamivir carboxylate in critically ill patients with pandemic (H1N1) influenza

Therapeutic Drug Monitoring
Florian LemaitreAlain Combes

Abstract

The neuraminidase inhibitor oseltamivir is a recommended treatment for influenza A (H1N1) infection. In rare cases, some patients develop influenza-associated multiple organ failures, requiring rescue therapies such as extracorporeal membrane oxygenation (ECMO) or continuous venovenous hemodiafiltration (CVVHDF). This study was designed to evaluate the impact of ECMO and CVVHDF on the pharmacokinetics of oseltamivir carboxylate (OC) in critically ill patients with pandemic (H1N1) influenza treated with oseltamivir. Seven critically ill patients on venovenous ECMO for severe pandemic (H1N1) influenza associated with acute respiratory distress syndrome were treated with various doses of oseltamivir (75 or 150 mg twice daily). Because of acute kidney injury, 3 of them also received CVVHDF. OC, the active form of oseltamivir, was quantified in plasma, and main pharmacokinetic parameters were determined. OC Cmax (1029 ± 478 ng/mL) and area under the curve (9.00 ± 4.52 mcg·h/mL) for patients on ECMO with preserved renal function were comparable with those of healthy volunteers or noncritically ill patients. Patients both on ECMO and CVVHDF had 4-to 5-fold higher OC Cmax and area under the curve. ECMO by itself did not impact on the p...Continue Reading

References

Oct 14, 2009·JAMA : the Journal of the American Medical Association·UNKNOWN Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza InvestigatorsMarc Ziegenfuss
Dec 25, 2009·The New England Journal of Medicine·Janice K LouieUNKNOWN California Pandemic (H1N1) Working Group

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Citations

Mar 21, 2016·European Journal of Drug Metabolism and Pharmacokinetics·Katharina KarschBarbara Rath
Feb 28, 2014·The Korean Journal of Internal Medicine·Won Suk ChoiUNKNOWN Transgovernmental Enterprise for Pandemic Influenza in Korea
Apr 19, 2015·Critical Care : the Official Journal of the Critical Care Forum·Florian LemaitreAlain Combes
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May 13, 2014·The Annals of Pharmacotherapy·Alexander H Flannery, Melissa L Thompson Bastin
Oct 10, 2018·Current Opinion in Infectious Diseases·Lore VanderbekeJoost Wauters
Apr 3, 2019·Critical Care Nurse·Adam SiegRickey Evans
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Jan 9, 2020·Intensive Care Medicine·Antoni TorresNelson Lee
Jan 1, 2014·Current Treatment Options in Infectious Diseases·Emily RoweYee-Sin Leo
Mar 23, 2017·Critical Care : the Official Journal of the Critical Care Forum·Amy L DzierbaDaniel Brodie
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Jun 14, 2019·Critical Care : the Official Journal of the Critical Care Forum·Eric J ChowTimothy M Uyeki
Nov 24, 2018·Médecine et maladies infectieuses·J B FoulquierF Lemaitre

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