European Journal of Clinical Pharmacology

, Volume 75, Issue 2, pp 287–288 | Cite as

No alteration of voriconazole concentration by plasmapheresis in a critically ill patient

  • Manuela Vay
  • Kathrin I. Foerster
  • Mazyar Mahmoudi
  • Jessica Seeßle
  • Gerd MikusEmail author
Letter to the Editor

Invasive pulmonary aspergillosis is a life-threatening disease with a mortality rate of 60–90% [1], if untreated. Patients with strongly suspected invasive aspergillosis should be treated with voriconazole immediately [2]. Due to its narrow therapeutic index, voriconazole therapeutic drug monitoring is often applied [3] (trough concentration > 1.5 μg/mL for efficacy but < 5–6 μg/mL to reduce toxicity [4]). A procedure like plasmapheresis may alter plasma concentrations and could decrease efficacy of voriconazole. Plasmapheresis affected significantly plasma concentrations of drugs (e.g. vancomycin, teicoplanin, verapamil [5]), resulting in subtherapeutic concentrations [5, 6]. However, plasmapheresis is a rarely used treatment and only limited data is available about the necessity of voriconazole dose adjustment [7].

A 66-year-old female patient (71 kg) with acute renal failure caused by recently diagnosed granulomatosis with polyangiitis required plasma exchange therapy. Her clinical...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent of the patient

Informed consent of the patient was obtained.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of Gastroenterology, Infectious Diseases, IntoxicationHeidelberg University HospitalHeidelbergGermany

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