Q: What is the caveat of using Echinocandins in a patient who is on extracorporeal membrane oxygenation (ECMO)?
Answer: subtherapeutic plasma levels
Although the example of Echinocadins i.e, caspofungin, micafungin, and anidulafungin has been used in this question, the objective is to introduce the caveat, limitations, and need of vigilance to watch the pharmacotherapeutic level of many drugs in patients who are on ECMO. Many drugs may get sequestered in the ECMO circuit and may cause subtherapeutic plasma levels.
The service of a clinical pharmacist should be sought and plasma levels should be monitored for important drugs.
#pharmacology
References:
1. Cheng V, Abdul-Aziz MH, Roberts JA, Shekar K. Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. J Thorac Dis. 2018;10(Suppl 5):S629-S641. doi:10.21037/jtd.2017.09.154
2. Spriet I, Annaert P, Meersseman P, et al. Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother 2009; 63:767.
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