Therapeutic plasma exchange (TPE) is an extracorporeal process in which a large volume of whole blood is taken from the patient’s vein. Plasma is then separated from the other cellular components of the blood and discarded while the remaining blood components may then be returned to the patient. Replacement fluids such as albumin or fresh-frozen plasma may or may not be used. TPE has been used clinically for the removal of pathologic targets in the plasma in a variety of conditions, such as pathogenic antibodies in autoimmune disorders. TPE is becoming more common in the neurointensive care space as autoimmunity has been shown to play an etiological role in many acute neurological disorders. It is important to note that not only does TPE removes pathologic elements from the plasma, but may also remove drugs, which may be an intended or unintended consequence. The objective of the current review is to provide an up-to-date summary of the available evidence pertaining to drug removal via TPE and provide relevant clinical suggestions where applicable. This review also aims to provide an easy-to-follow clinical tool in order to determine the possibility of a drug removal via TPE given the procedure-specific and pharmacokinetic drug properties.
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El-Ghariani K, Unsworth DJ. Therapeutic apheresis–plasmapheresis. Clin Med (Lond). 2006;6(4):343–7.
Shelat SG. Practical considerations for planning a therapeutic apheresis procedure. Am J Med. 2010;123(9):777–84.
Szczepiorkowski ZM, Bandarenko N, Kim HC, et al. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2007;22(3):106–75.
Abel JJ, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmaphaeresis). J Pharmacol Exp Ther. 1914; 5(6). Transfus Sci. 1990;11(2):166–77.
Cheng CW, Hendrickson JE, Tormey CA, Sidhu D. Therapeutic plasma exchange and its impact on drug levels: an ACLPS critical review. Am J Clin Pathol. 2017;148(3):190–8.
Ibrahim RB, Liu C, Cronin SM, et al. Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy. 2007;27(11):1529–49.
Ibrahim RB, Balogun RA. Medications in patients treated with therapeutic plasma exchange: prescription dosage, timing, and drug overdose. Semin Dial. 2012;25(2):176–89.
Kale-Pradhan PB, Woo MH. A review of the effects of plasmapheresis on drug clearance. Pharmacotherapy. 1997;17(4):684–95.
Keller F, Wagner K, Faber U, et al. Elimination kinetics of plasma exchange. Klin Wochenschr. 1983;61(22):1115–22.
Fauvelle F, Petitjean O, Tod M, Guillevin L. Clinical pharmacokinetics during plasma exchange. Therapie. 2000;55(2):269–75.
McClellan SD, Whitaker CH, Friedberg RC. Removal of vancomycin during plasmapheresis. Ann Pharmacother. 1997;31(10):1132–6.
Nasca TJ, Huff N, Livengood BH. Phenytoin pharmacokinetics in therapeutic plasmapheresis. J Clin Pharmacol. 1985;25:302–4.
Mansur LI, Murrow RW, Garrelts JC, Minns GO. Rebound of plasma free phenytoin concentration following plasmapheresisin a patient with thrombotic thrombocytopenic purpura. Ann Pharmacother. 1995;29(6):592–5.
Kale PB, Thomson PA, Provenzano R, Higgins MJ. Evaluation of plasmapheresis in the treatment of an acute overdose of carbamazepine. Ann Pharmacother. 1993;27:866–70.
Bertino JS, Kliegman RM, Myers CM, Blumer JL. Alterations in gentamicin pharmacokinetics during neonatal exchange-transfusion. Dev Pharmacol Ther. 1982;4(3–4):205–15.
Ouellette SM, Visconti JA, Kennedy MS. A pharmacokinetic evaluation of the effect of plasma exchange on tobramycin disposition. Clin Exp Dial Apher. 1983;7:225–33.
Jones JS, Dougherty J. Current status of plasmapheresis in toxicology. Ann Emerg Med. 1986;15(4):474–82.
Haller C. Hypoalbuminemia in renal failure: pathogenesis and therapeutic considerations. Kidney Blood Press Res. 2005;28(5–6):307–10.
Huang Z, Ung T. Effect of alpha-1-acid glycoprotein binding on pharmacokinetics and pharmacodynamics. Curr Drug Metab. 2013;14(2):226–38.
Cabrerizo S, Cuadras D, Gomez-Busto F, et al. Serum albumin and health in older people: review and meta analysis. Maturitas. 2015;81(1):17–27.
Ghannoum M, Roberts DM, Hoffman RS, et al. A stepwise approach for the management of poisoning with extracorporeal treatments. Semin Dial. 2014;27(4):362–70.
Choi JH, Oh JC, Kim KH, et al. Successful treatment of cisplatin overdose with plasma exchange. Yonsei Med J. 2002;43(1):128–32.
Samtleben W, Mistry-Burchardi N, Hartmann B, Lennertz A, Bosch T. Therapeutic plasma exchange in the intensive care setting. Ther Apher. 2001;5(5):351–7.
Khan E, Huggan P, Celi L, et al. Sustained low-efficiency dialysis with filtration (SLEDD-f) in the management of acute sodium valproate intoxication. Hemodial Int. 2008;12(2):211–4.
Kintzel PE, Eastlund T, Calis KA. Extracorporeal removal of antimicrobials during plasmapheresis. J Clin Apher. 2003;18(4):194–205.
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.
Lavergne V, Nolin TD, Hoffman RS, et al. The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: guideline methodology. Clin Toxicol (Phila). 2012;50(5):403–13.
Unal S, Bayrakci B, Yasar U, Karagoz T. Successful treatment of propafenone, digoxin and warfarin overdosage with plasma exchange therapy and rifampicin. Clin Drug Investig. 2007;27(7):505–8.
Chavanet PY, Bailly F, Mousson C, et al. Acyclovir pharmacokinetics in plasmapheresis. J Clin Apher. 1990;5(2):68–9.
Monroig-Bosque PDC, Balk J, Segura F, et al. The utility of therapeutic plasma exchange for amphotericin B overdose. Transfus Apheres Sci. 2018;57:756–8.
Wang GS, Banerji S, Roussil TK, et al. Survival after amphotericin B overdose treated with plasmapheresis. Ann Pharmacother. 2013;47:e9.
Lew SQ. Amphotericin B removal by plasma exchange. J Clin Pharm Ther. 2009;34:115–7.
Prince AS, Kliegman R, Phaneuf D, Neu HC. The effect of exchange-transfusion on the blood-levels of ampicillin and gentamicin in neonates. Infection. 1981;9(1):2–6.
Ibrahim RB, Liu CY, Cronin SM, et al. Influence of plasma exchange on the disposition of the fourth generation cephalosporin cefepime. J Oncol Pharm Pract. 2009;15(4):217–22.
Bozkurt F, Schollmeyer P, Keller E. Kinetics of ceftazidime during plasmapheresis. Eur J Clin Pharmacol. 1987;33:197–201.
Fauvelle F, Lortholary O, Tod M, et al. Pharmacokinetics of ceftriaxone during plasma exchange in polyarteritis nodosa patients. Antimicrob Agents Chemother. 1994;38:1519–22.
Bakken JS, Cavalieri SJ, Gangeness D, et al. Influence of therapeutic plasmapheresis on elimination of ceftiaxone. Antimicrob Agents Chemother. 1993;37:1171–3.
Kessler DL Jr, Smith AL, Woodrum DE. Chloramphenicol toxicity in a neonate treated with exchange transfusion. J Pediatr. 1980;96(1):140–1.
Berlin G, Brodin B, Hilden JO, Martensson J. Acute dapsone intoxication: a case treated with continuous infusion of methylene blue, forced diuresis and plasma exchange. J Toxicol Clin Toxicol. 1984;22(6):537–48.
Garcia M, Le Moal G, Dupuis A, et al. Plasma exchange significantly affects darunavir exposure. J Antimicrob Chemother. 2014;69:2296–7.
Nunez-Nunez M, Bellapart J, O’Donoghue S, et al. Variable ganciclovir concentrations in a critically ill patient receiving continuous renal replacement therapy and plasma exchange? Int J Antimicrob Agents. 2014;43(6):572–3.
Kliegman RM, Bertino JS, Fanaroff AA, Gavan TL, Speck WT. Pharmacokinetics of gentamicin during exchange transfusions in neonates. J Pediatr. 1980;96(5):927–30.
Fuquay D, Koup J, Epstein MF, Smith AL. Effect of exchange transfusion on serum gentamicin concentrations. Dev Pharmacol Ther. 1981;3(4):214–21.
Roberts JA, Roberts MS, Robertson TA, et al. A novel way to investigate the effects of plasma exchange on antibiotic levels: use of microdialysis. Int J Antimicrob Agents. 2008;31:240–4.
Kale-Pradhan PB, Dehoorne-Smith ML, Jaworski DA, et al. Evaluation of plasmapheresis on the removal of tobramycin. Pharmacotherapy. 1995;15:673–6.
Appelgate R, Schwartz D, Bennett WM. Removal of tobramycin during plasma exchange therapy. Ann Intern Med. 1981;94(6):820–1.
Sirvent AE, Borras-Blasco J, Enriquez R, Navarro-Ruiz A, Amoros FA. Extracorporeal removal of vancomycin by plasmapheresis. Ann Pharmacother. 2006;40(12):2279–80.
Foral MA, Heineman SM. Vancomycin removal during a plasma exchange transfusion. Ann Pharmacother. 2001;35(11):1400–2.
Osman BA, Lew SQ. Vancomycin removal by plasmapheresis. Pharmacol Toxicol. 1997;81(5):245–6.
Brophy DF, Mueller BA. Vancomycin removal by plasmapheresis. Ann Pharmacother. 1996;30(9):1038.
Vay M, Foerster KI, Mahmoudi M, Seessle J, Mikus G. No alteration of voriconazole concentration by plasmapheresis in a critically ill patient. Eur J Clin Pharmacol. 2019;75(2):287–8.
Spriet I, Bruggemann RJM, Annaert P, et al. Pharmacokinetic profile of voriconazole in a critically Ill patient on therapeutic plasma exchange. Ther Drug Monit. 2013;35:141–3.
Fauvelle F, Leon A, Petitjean O, Guillevin L. Zidovudine removal during plasma exchange. J Clin Apher. 1991;6(3):155–7.
Agulnik A, Kelly DP, Bruccoleri R, et al. combination clearance therapy and barbiturate coma for severe carbamazepine overdose. Pediatrics. 2017;139:e20161560.
Kozanoglu I, Kahveci S, Asma S, et al. Plasma-exchange treatment for severe carbamazepine intoxication: a case study. J Clin Apher. 2014;29(3):178–80.
Gambi D, Oggioni R, Mangani V, et al. Acute carbamazepine poisoning treated with plasmapheresis. Description of a clinical case. Min Anestesiol. 1993;59(10):547–52.
Siddiqi ZA, Holt A, Ahmed SN. Effect of plasma exchange on carbamazepine levels in a patient with myasthenia gravis and epilepsy. Epilepsia. 2005;46(11):1841–2.
Duzova A, Baskin E, Usta Y, Ozen S. Carbamazepine poisoning: treatment with plasma exchange. Hum Exp Toxicol. 2001;20(4):175–7.
Hau Man TH, Shek-Kwan CR, On-Kei CA, Lam CPW. Effect of plasmapheresis on serum levels of clobazam, levetiracetam and topiramate. Epilepsy Behav Case Rep. 2017;8:66–8.
Peters BJ, Hofer M, Daniels CE, et al. Effect of plasma exchange on antifactor Xa activity of enoxaparin and serum levetiracetam levels. Am J Health Syst Pharm AJHP Off J Am Soc Health Syst Pharm. 2018;75:1883–8.
Christensen J, Balslev T, Villadsen J, et al. Removal of 10-hydroxycarbazepine by plasmapheresis. Ther Drug Monit. 2001;23:374–9.
Sagraves R, Bradberry JC. The effects of exchange transfusion on the pharmacokinetics of phenobarbital. Drug Intell Clin Pharm. 1983;17(12):901–3.
Lai CW, Leppik IE, Jenkins DC, Sood P. Epilepsy, myasthenia gravis, and effect of plasmapheresis on antiepileptic drug concentrations. Arch Neurol. 1990;47(1):66–8.
Olsen KM, Marx MA, Monaghan MS, et al. Phenytoin and plasmapheresis: importance of sampling times and impact of obesity. Ther Drug Monit. 1994;16(6):624–8.
Tobias JD, Baker DK, Hurwitz CA, et al. Removal of phenytoin by plasmapheresis in a patient with thrombotic thrombocytopenia purpura. Clin Pediatr. 1992;31:105–8.
White RL, Garnett WR, Allen JH, Kline BJ, Sharp DE. Phenytoin removal during plasma exchange. J Clin Apher. 1987;3(3):147–50.
Liu E, Rubenstein M. Phenytoin removal by plasmapheresis in thrombotic thrombocytopenic purpura. Clin Pharmacol Ther. 1982;31:762–5.
Larsen LS, Sterrett JR, Whitehead B, Marcus SM. Adjunctive therapy of phenytoin overdose—a case report using plasmaphoresis. J Toxicol Clin Toxicol. 1986;24(1):37–49.
Silberstein LE, Shaw LM. Effect of plasma exchange on phenytoin plasma concentration. Ther Drug Monit. 1986;8(2):172–6.
Brown-Molnar CS, Bauer LA, Horn JR. Phenytoin removal by plasmapheresis in renal insufficiency. Am J Nephrol. 1986;6(4):302–6.
Bastiaans DET, van Uden IWM, Ruiterkamp RA, et al. Removal of valproic acid by plasmapheresis in a patient treated for multiple sclerosis. Ther Drug Monit. 2013;35:1–3.
White RL, Garnett WR, Poynor WJ, Allen JH, Sharp DE. Salicylate removal during plasma exchange in normal volunteers. Clin Pharm. 1984;3(4):396–402.
Lam WW, Reyes MA, Seger JJ. Plasma exchange for urgent Apixaban reversal in a case of hemorrhagic tamponade after pacemaker implantation. Tex Heart Inst J. 2015;42(4):377–80.
Schinzel H, Berghoff K, Beuermann I, et al. Anticoagulation with low-molecular-weight heparin (dalteparin) in plasmapheresis therapy: initial experience. Transfusion. 2006;46(4):624–9.
Sabloff M, Wells PS. The effect of plasmapheresis on the serum activity level of dalteparin: a case report. Blood Coagul Fibrinolysis. 2000;11(4):395–400.
Rahawi KW, Higgins KL, Noda C, Stultz JS. Effect of plasmapheresis on the anti-factor Xa activity of enoxaparin in an obese adolescent patient. Pharmacotherapy. 2017;37(4):e16–20.
Kaplan A, Raut P, Totoe G, et al. Management of systemic unfractionated heparin anticoagulation during therapeutic plasma exchange. J Clin Apher. 2016;31:507–15.
Kumar V, Allencherril J, Bracey A, Chen AJ, Lam WW. Therapeutic plasma exchange for urgent rivaroxaban reversal. Tex Heart Inst J. 2018;45:96–8.
Unal S, Bayrakci B, Yasar U, et al. Successful treatment of propafenone, digoxin and warfarin overdosage with plasma exchange therapy and rifampicin. Clin Drug Investig. 2007;27:505–8.
Zantek ND, Morgan S, Zantek PF, et al. Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin. J Clin Apher. 2014;29(2):75–82.
Uzzan B, Pussard E, Leon A, et al. The effects of plasmapheresis on thyroid hormone and plasma drug concentrations in amiodarone-induced thyrotoxicosis. Br J Clin Pharmacol. 1991;31(3):371–2.
Russell DC, Paton L, Douglas AC. Amiodarone associated alveolitis and polyarthropathy. Treatment by plasma exchange. Br Heart J. 1983;50(5):491–4.
Chudow M, Ferguson K. A case of severe, refractory hypotension after amlodipine overdose. Cardiovasc Toxicol. 2018;18(2):192–7.
Ezidiegwu C, Spektor Z, Nasr MR, et al. A case report on the role of plasma exchange in the management of a massive amlodipine besylate intoxication. Ther Apher Dial. 2008;12:180–4.
Koschny R, Lutz M, Seckinger J, et al. Extracorporeal life support and plasmapheresis in a case of severe polyintoxication. J Emerg Med. 2014;47:527–31.
Rajpal S, Beedupalli J, Reddy P. Recrudescent digoxin toxicity treated with plasma exchange: a case report and review of literature. Cardiovasc Toxicol. 2012;12(4):363–8.
Keller F, Kreutz G, Vohringer HF, et al. Effect of plasma exchange on the steady-state kinetics of digoxin and digitoxin. Clin Pharmacokinet. 1985;10:514–23.
Rabetoy GM, Price CA, Findlay JW, et al. Treatment of digoxin intoxication in a renal failure patient with digoxin-specific antibody fragments and plasmapheresis. Am J Nephrol. 1990;10:518–21.
Coltart DJ, Watson D, Howard MR. Effect of exchange transfusions on plasma digoxin levels. Arch Dis Child. 1972;47(255):814–5.
Rosegger H, Zach M, Gleispach H, Beitzke A. Digoxin elimination by exchange transfusion. Eur J Pediatr. 1977;124(3):217–22.
Keller F, Hauff A, Schultze G, et al. Effect of repeated plasma exchange on steady state kinetics of digoxin and digitoxin. Arzneimittelforschung. 1984;34(1):83–6.
Gutschmidt HJ. Successful plasmapheresis in severe diltiazem poisoning. Dtsch Med Wochenschr. 1995;120(3):81–2.
Martin SG, Kearns GL, Brod M, Austin G, Vaughan BC. Impact of plasmapheresis on disopyramide elimination. Pediatr Nephrol. 1999;13(4):323–5.
Evers J, Messer W, Aboudan F, Finke K. Mexiletine in terminal renal failure and various dialysis procedures. Klin Wochenschr. 1989;67(19):995–8.
Chen L-W, Mao DR, Chen Y-S. Extracorporeal life support: the final ‘antidote’ for massive propranolol overdose. Hong Kong J Emerg Med. 2019;26(2):118–23.
Kolcz J, Pietrzyk J, Januszewska K, et al. Extracorporeal life support in severe propranolol and verapamil intoxication. J Intensive Care Med. 2007;22:381–5.
Talbert RL, Wong YY, Duncan DB. Propranolol plasma concentrations and plasmapheresis. Drug Intell Clin Pharm. 1981;15(12):993–6.
Kuhlmann U, Schoenemann H, Muller T, Keuchel M, Lange H. Plasmapheresis in life-threatening verapamil intoxication. Artif Cells Blood Substit Immobil Biotechnol. 2000;28:429–40.
Siebenlist D. Plasma separation in verapamil poisoning. Dtsch Med Wochenschr. 1990;115(20):797.
Nojima M, Yoshimoto T, Nakao A, et al. Sequential blood level monitoring of basiliximab during multisession plasmapheresis in a kidney transplant recipient. Transpl Proc. 2005;37:875–8.
Okechukwu CN, Meier-Kriesche HU, Armstrong D, et al. Removal of basiliximab by plasmapheresis. Am J Kidney Dis. 2001;37(1):E11.
Emir S, Ozyoruk D, Arman O, et al. Accidental cisplatin overdose in a child: successful management with repetitive plasmapheresis and use of chemoprotective agents. Turk J Pediatr. 2016;58:315–7.
Chu G, Mantin R, Shen YM, et al. Massive cisplatin overdose by accidental substitution for carboplatin. Toxicity and management. Cancer. 1993;72:3707–14.
Hofmann G, Bauernhofer T, Krippl P, et al. Plasmapheresis reverses all side-effects of a cisplatin overdose—a case report and treatment recommendation. BMC Cancer. 2006;6:1.
Jung HK, Lee J, Lee SN. A case of massive cisplatin overdose managed by plasmapheresis. Korean J Intern Med. 1995;10:150–4.
Balogun RA, Sahadevan M, Sevigny J, et al. Impact of therapeutic plasma exchange on cyclosporine kinetics during membrane-based lipid apheresis. Am J Kidney Dis. 2001;37:1286–9.
Moorman MT, Epstein RB, Smith JW, et al. Management of cyclosporine overdose in a hematopoietic stem cell transplant patient with sequential plasma exchange and red blood cell exchange. J Clin Apher. 2011;26:156–8.
Chan GL, Hodge EE. Effect of plasmapheresis on cyclosporine pharmacokinetics. DICP. 1991;25(2):211.
Kwon SU, Lim SH, Rhee I, et al. Successful whole blood exchange by apheresis in a patient with acute cyclosporine intoxication without long-term sequelae. J Heart Lung Transpl. 2006;25(4):483–5.
Leitner GC, Hiesmayr M, Hoecker P, Jilma B. Therapeutic approaches in the management of oral cyclosporine a intoxication. Transplantation. 2003;75(10):1764–5.
Cecyn KZ, Lee J, Oguro T, Petrilli AS, Bordin JO. Use of plasma exchange in methotrexate removal in a patient with osteosarcoma and acute renal insufficiency. Am J Hematol. 2003;72(3):209–11.
Kepka L, De Lassence A, Ribrag V, et al. Successful rescue in a patient with high dose methotrexate-induced nephrotoxicity and acute renal failure. Leuk lymphoma. 1998;29:205–9.
Thierry FX, Vernier I, Dueymes JM, et al. Acute renal failure after high-dose methotrexate therapy. Role of hemodialysis and plasma exchange in methotrexate removal. Nephron. 1989;51:416–7.
Maldonado AQ, Davies NM, Crow SA, et al. Effects of plasmapheresis on mycophenolic acid concentrations. Transplantation. 2011;91(1):e3–4.
Kawauchi S, Wada K, Oita A. Changes in blood concentration of mycophenolic acid and FK506 in a heart-transplant patient treated with plasmapheresis. Int J Clin Pharmacol Ther. 2019;57(1):32–6.
Khatri BO, Man S, Giovannoni G, et al. Effect of plasma exchange in accelerating natalizumab clearance and restoring leukocyte function. Neurology. 2009;72:402–9.
Stigelman WH Jr, Henry DH, Talbert RL, Townsend RJ. Removal of prednisone and prednisolone by plasma exchange. Clin Pharm. 1984;3(4):402–7.
Wienzek-Lischka S, Burchardt A, Schoelz C, et al. Plasma exchange (PE) therapy for rituximab (R) induced progressive multifocal leukoencephalopathy (PML) in hematologic disorders. Plenary and keynote speakers summaries. Transf Med Hemother. 2013;40(suppl 1):76.
Azzopardi N, Francois M, Laurent E, Paintaud G, Birmele B. Influence of plasma exchange on rituximab pharmacokinetics. Br J Clin Pharmacol. 2013;76:486–8.
Puisset F, White-Koning M, Kamar N, et al. Population pharmacokinetics of rituximab with or without plasmapheresis in kidney patients with antibody-mediated disease. Br J Clin Pharmacol. 2013;76(5):734–40.
McDonald V, Manns K, Mackie IJ, Machin SJ, Scully MA. Rituximab pharmacokinetics during the management of acute idiopathic thrombotic thrombocytopenic purpura. J Thromb Haemost. 2010;8:1201–8.
Kawauchi S, Wada K, Oita A. Changes in blood concentration of mycophenolic acid and FK in a heart-transplant patient treated with plasmapheresis. Int J Clin Pharmacol Ther. 2019;57:32–6.
Hale GA, Reece DE, Munn RK, Kniska AB, Phillips GL. Blood tacrolimus concentrations in bone marrow transplant patients undergoing plasmapheresis. Bone Marrow Transpl. 2000;25(4):449–51.
Przepiorka D, Suzuki J, Ippoliti C, Hester JP, Fritsche HA. Blood tacrolimus concentration unchanged by plasmapheresis. Am J Hosp Pharm. 1994;51(13):1708.
Kosmidis HV, Bouhoutsou DO, Varvoutsi MC, et al. Vincristine overdose: experience with 3 patients. Pediatr Hematol Oncol. 1991;8(2):171–8.
Pierga JY, Beuzeboc P, Dorval T, et al. Favourable outcome after plasmapheresis for vincristine overdose. Lancet. 1992;340:185.
Fauvelle F, Nicolas P, Leon A, et al. Diclofenac, paracetamol, and vidarabine removal during plasma exchange in polyarteritis nodosa patients. Biopharm Drug Dispos. 1991;12:411–24.
Sari I, Turkcuer I, Erurker T, et al. Therapeutic plasma exchange in amitriptyline intoxication: case report and review of the literature. Transfus Apher Sci. 2011;45(2):183–5.
Karaci M, Ozcetin M, Dilsiz G, Guclu-Songur YG. Severe childhood amitriptyline intoxication and plasmapheresis: a case report. Turk J Pediatr. 2013;55(6):645–7.
Bayrakci B, Unal S, Erkocoglu M, Gungor HY, Aksu S. Case reports of successful therapeutic plasma exchange in severe amitriptyline poisoning. Ther Apher Dial. 2007;11(6):452–4.
Belen B, Akman A, Yuksel N, et al. A case report of amitriptyline poisoning successfully treated with the application of plasma exchange. Ther Apher Dial. 2009;13(2):147–9.
Kolsal E, Tekin IO, Piskin E, et al. Treatment of severe amitriptyline intoxication with plasmapheresis. J Clin Apher. 2009;24(1):21–4.
Geith S, Renner B, Rabe C, et al. Ibuprofen plasma concentration profile in deliberate ibuprofen overdose with circulatory depression treated with therapeutic plasma exchange: a case report. BMC Pharmacol Toxicol. 2017;18:81.
Sabto JK, Pierce RM, West RH, Gurr FW. Hemodialysis, peritoneal dialysis, plasmapheresis and forced diuresis for the treatment of quinine overdose. Clin Nephrol. 1981;16(5):264–8.
Assael BM, Caccamo ML, Gerna M, et al. Effect of exchange transfusion on elimination of theophylline in premature neonates. J Pediatr. 1977;91(2):331–2.
Laussen P, Shann F, Butt W, Tibballs J. Use of plasmapheresis in acute theophylline toxicity. Crit Care Med. 1991;19(2):288–90.
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Mahmoud, S.H., Buhler, J., Chu, E. et al. Drug Dosing in Patients Undergoing Therapeutic Plasma Exchange. Neurocrit Care 34, 301–311 (2021). https://doi.org/10.1007/s12028-020-00989-1
- TPE plasma exchange
- Drug removal