The pharmacokinetics of oseltamivir and oseltamivir carboxylate in a critically ill pediatric patient receiving extracorporeal membrane oxygenation and continuous venovenous hemodialysis
- PMID: 23118670
- PMCID: PMC3470438
- DOI: 10.5863/1551-6776-17.2.173
The pharmacokinetics of oseltamivir and oseltamivir carboxylate in a critically ill pediatric patient receiving extracorporeal membrane oxygenation and continuous venovenous hemodialysis
Abstract
This report details the pharmacokinetics of oseltamivir and oseltamivir carboxylate following administration of high-dose oseltamivir in a critically ill child receiving extracorporeal membrane oxygenation (ECMO) and continuous venovenous hemodialysis (CVVHD). A 6-year-old critically ill male patient suffering from a presumed viral illness was transferred to our institution's pediatric intensive care unit from an outside hospital after developing respiratory failure and cardiomegaly. ECMO and oseltamivir therapy were initiated upon admission, and CVVHD was started on hospital day 3. Pharmacokinetic sampling occurred at an oseltamivir dose of approximately 4 mg/kg on hospital day 6. The patient's oseltamivir and oseltamivir carboxylate area under the plasma concentration time curves for the 12-hour dosing interval (AUC(0-12)) were 30.5 and 905 ng/mLhr, respectively. Drug clearance by CVVHD was 31.6 mL/min for oseltamivir and 26.9 mL/min for oseltamivir carboxylate. Pre- and postoxygenator oseltamivir and oseltamivir carboxylate plasma concentrations did not differ substantially. The patient's oseltamivir carboxylate plasma concentrations remained well above the reported mean 50% inhibitory concentration for 2009 pandemic H1N1 virus. However, despite receiving twice the standard dose of oseltamivir, the oseltamivir carboxylate AUC(0-12) in our patient was less than that reported in noncritically ill pediatric subjects. The reduced oseltamivir carboxylate AUC(0-12) found in our patient was most likely due to decreased drug absorption.
Keywords: continuous renal replacement therapy; dialysis; extracorporeal membrane oxygenation; influenza; oseltamivir.
Similar articles
-
Pharmacokinetics of oseltamivir and oseltamivir carboxylate in critically ill patients receiving continuous venovenous hemodialysis and/or extracorporeal membrane oxygenation.Pharmacotherapy. 2012 Dec;32(12):1061-9. doi: 10.1002/phar.1151. Pharmacotherapy. 2012. PMID: 23208833
-
Impact of extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration on the pharmacokinetics of oseltamivir carboxylate in critically ill patients with pandemic (H1N1) influenza.Ther Drug Monit. 2012 Apr;34(2):171-5. doi: 10.1097/FTD.0b013e318248672c. Ther Drug Monit. 2012. PMID: 22354159
-
Oseltamivir pharmacokinetics in critically ill adults receiving extracorporeal membrane oxygenation support.Anaesth Intensive Care. 2013 Jan;41(1):66-73. doi: 10.1177/0310057X1304100112. Anaesth Intensive Care. 2013. PMID: 23362894 Clinical Trial.
-
Oseltamivir Dosing in Critically Ill Patients With Severe Influenza.Ann Pharmacother. 2014 Aug;48(8):1011-1018. doi: 10.1177/1060028014535362. Epub 2014 May 9. Ann Pharmacother. 2014. PMID: 24816209 Review.
-
Oseltamivir in seasonal, avian H5N1 and pandemic 2009 A/H1N1 influenza: pharmacokinetic and pharmacodynamic characteristics.Clin Pharmacokinet. 2010 Nov;49(11):741-65. doi: 10.2165/11534730-000000000-00000. Clin Pharmacokinet. 2010. PMID: 20923248 Review.
Cited by
-
Pharmacokinetics of Commonly Used Medications in Children Receiving Continuous Renal Replacement Therapy: A Systematic Review of Current Literature.Clin Pharmacokinet. 2022 Feb;61(2):189-229. doi: 10.1007/s40262-021-01085-z. Epub 2021 Nov 30. Clin Pharmacokinet. 2022. PMID: 34846703 Free PMC article.
-
Pharmacokinetics Alterations in Critically Ill Pediatric Patients on Extracorporeal Membrane Oxygenation: A Systematic Review.Front Pediatr. 2020 Jun 26;8:260. doi: 10.3389/fped.2020.00260. eCollection 2020. Front Pediatr. 2020. PMID: 32670992 Free PMC article.
-
Influenza virus-related critical illness: prevention, diagnosis, treatment.Crit Care. 2019 Jun 12;23(1):214. doi: 10.1186/s13054-019-2491-9. Crit Care. 2019. PMID: 31189475 Free PMC article. Review.
-
Drugs pharmacokinetics during veno-venous extracorporeal membrane oxygenation in pediatrics.J Thorac Dis. 2018 Mar;10(Suppl 5):S642-S652. doi: 10.21037/jtd.2017.11.02. J Thorac Dis. 2018. PMID: 29732182 Free PMC article. Review.
-
Pharmacokinetics of Oral and Intravenous Oseltamivir Treatment of Severe Influenza B Virus Infection Requiring Organ Replacement Therapy.Eur J Drug Metab Pharmacokinet. 2017 Feb;42(1):155-164. doi: 10.1007/s13318-016-0330-9. Eur J Drug Metab Pharmacokinet. 2017. PMID: 26994602
References
-
- Genentech. Tamiflu prescribing information. Genentech, USA; South San Francisco, CA: 2011. http://www.gene.com/gene/products/information/tamiflu/pdf/pi.pdf. Accessed July 14, 2012.
-
- Mulla H, McCormack P, Lawson G, et al. Pharmacokinetics of midazolam in neonates undergoing extracorporeal membrane oxygenation. Anesthesiology. 2003;99(2):275–282. - PubMed
-
- Eyler RF, Heung M, Pleva M, et al. Oseltamivir and Oseltamivir Carboxylate Pharmacokinetics in Critically Ill Patients Receiving Continuous Venovenous Hemodialysis [abstract A1–1999] Proceedings of the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy. Boston, MA. September 15, 2010.
Publication types
LinkOut - more resources
Full Text Sources