No alteration of voriconazole concentration by plasmapheresis in a critically ill patient
Invasive pulmonary aspergillosis is a life-threatening disease with a mortality rate of 60–90% , if untreated. Patients with strongly suspected invasive aspergillosis should be treated with voriconazole immediately . Due to its narrow therapeutic index, voriconazole therapeutic drug monitoring is often applied  (trough concentration > 1.5 μg/mL for efficacy but < 5–6 μg/mL to reduce toxicity ). 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 ), 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 .
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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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