Skip to main content

Advertisement

Log in

Drug Dosing in Patients Undergoing Therapeutic Plasma Exchange

  • Review Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. El-Ghariani K, Unsworth DJ. Therapeutic apheresis–plasmapheresis. Clin Med (Lond). 2006;6(4):343–7.

    Article  PubMed Central  Google Scholar 

  2. Shelat SG. Practical considerations for planning a therapeutic apheresis procedure. Am J Med. 2010;123(9):777–84.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. Ibrahim RB, Liu C, Cronin SM, et al. Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy. 2007;27(11):1529–49.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. Kale-Pradhan PB, Woo MH. A review of the effects of plasmapheresis on drug clearance. Pharmacotherapy. 1997;17(4):684–95.

    CAS  PubMed  Google Scholar 

  9. Keller F, Wagner K, Faber U, et al. Elimination kinetics of plasma exchange. Klin Wochenschr. 1983;61(22):1115–22.

    Article  CAS  PubMed  Google Scholar 

  10. Fauvelle F, Petitjean O, Tod M, Guillevin L. Clinical pharmacokinetics during plasma exchange. Therapie. 2000;55(2):269–75.

    CAS  PubMed  Google Scholar 

  11. McClellan SD, Whitaker CH, Friedberg RC. Removal of vancomycin during plasmapheresis. Ann Pharmacother. 1997;31(10):1132–6.

    Article  CAS  PubMed  Google Scholar 

  12. Nasca TJ, Huff N, Livengood BH. Phenytoin pharmacokinetics in therapeutic plasmapheresis. J Clin Pharmacol. 1985;25:302–4.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  CAS  Google Scholar 

  17. Jones JS, Dougherty J. Current status of plasmapheresis in toxicology. Ann Emerg Med. 1986;15(4):474–82.

    Article  CAS  PubMed  Google Scholar 

  18. Haller C. Hypoalbuminemia in renal failure: pathogenesis and therapeutic considerations. Kidney Blood Press Res. 2005;28(5–6):307–10.

    Article  CAS  PubMed  Google Scholar 

  19. Huang Z, Ung T. Effect of alpha-1-acid glycoprotein binding on pharmacokinetics and pharmacodynamics. Curr Drug Metab. 2013;14(2):226–38.

    CAS  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Choi JH, Oh JC, Kim KH, et al. Successful treatment of cisplatin overdose with plasma exchange. Yonsei Med J. 2002;43(1):128–32.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Kintzel PE, Eastlund T, Calis KA. Extracorporeal removal of antimicrobials during plasmapheresis. J Clin Apher. 2003;18(4):194–205.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. 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.

    Article  CAS  PubMed  Google Scholar 

  29. Chavanet PY, Bailly F, Mousson C, et al. Acyclovir pharmacokinetics in plasmapheresis. J Clin Apher. 1990;5(2):68–9.

    CAS  PubMed  Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. Wang GS, Banerji S, Roussil TK, et al. Survival after amphotericin B overdose treated with plasmapheresis. Ann Pharmacother. 2013;47:e9.

    Article  PubMed  Google Scholar 

  32. Lew SQ. Amphotericin B removal by plasma exchange. J Clin Pharm Ther. 2009;34:115–7.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. 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.

    Article  CAS  PubMed  Google Scholar 

  35. Bozkurt F, Schollmeyer P, Keller E. Kinetics of ceftazidime during plasmapheresis. Eur J Clin Pharmacol. 1987;33:197–201.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Bakken JS, Cavalieri SJ, Gangeness D, et al. Influence of therapeutic plasmapheresis on elimination of ceftiaxone. Antimicrob Agents Chemother. 1993;37:1171–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kessler DL Jr, Smith AL, Woodrum DE. Chloramphenicol toxicity in a neonate treated with exchange transfusion. J Pediatr. 1980;96(1):140–1.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Garcia M, Le Moal G, Dupuis A, et al. Plasma exchange significantly affects darunavir exposure. J Antimicrob Chemother. 2014;69:2296–7.

    Article  CAS  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  CAS  Google Scholar 

  42. 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.

    Article  CAS  PubMed  Google Scholar 

  43. Fuquay D, Koup J, Epstein MF, Smith AL. Effect of exchange transfusion on serum gentamicin concentrations. Dev Pharmacol Ther. 1981;3(4):214–21.

    Article  CAS  PubMed  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. Kale-Pradhan PB, Dehoorne-Smith ML, Jaworski DA, et al. Evaluation of plasmapheresis on the removal of tobramycin. Pharmacotherapy. 1995;15:673–6.

    Article  CAS  PubMed  Google Scholar 

  46. Appelgate R, Schwartz D, Bennett WM. Removal of tobramycin during plasma exchange therapy. Ann Intern Med. 1981;94(6):820–1.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. Foral MA, Heineman SM. Vancomycin removal during a plasma exchange transfusion. Ann Pharmacother. 2001;35(11):1400–2.

    Article  CAS  PubMed  Google Scholar 

  49. Osman BA, Lew SQ. Vancomycin removal by plasmapheresis. Pharmacol Toxicol. 1997;81(5):245–6.

    Article  CAS  PubMed  Google Scholar 

  50. Brophy DF, Mueller BA. Vancomycin removal by plasmapheresis. Ann Pharmacother. 1996;30(9):1038.

    Article  CAS  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  CAS  PubMed  Google Scholar 

  53. Fauvelle F, Leon A, Petitjean O, Guillevin L. Zidovudine removal during plasma exchange. J Clin Apher. 1991;6(3):155–7.

    Article  CAS  PubMed  Google Scholar 

  54. Agulnik A, Kelly DP, Bruccoleri R, et al. combination clearance therapy and barbiturate coma for severe carbamazepine overdose. Pediatrics. 2017;139:e20161560.

    Article  PubMed  Google Scholar 

  55. 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.

    Article  PubMed  Google Scholar 

  56. 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.

    CAS  Google Scholar 

  57. 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.

    Article  PubMed  Google Scholar 

  58. Duzova A, Baskin E, Usta Y, Ozen S. Carbamazepine poisoning: treatment with plasma exchange. Hum Exp Toxicol. 2001;20(4):175–7.

    Article  CAS  PubMed  Google Scholar 

  59. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  60. 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.

    Article  Google Scholar 

  61. Christensen J, Balslev T, Villadsen J, et al. Removal of 10-hydroxycarbazepine by plasmapheresis. Ther Drug Monit. 2001;23:374–9.

    Article  CAS  PubMed  Google Scholar 

  62. Sagraves R, Bradberry JC. The effects of exchange transfusion on the pharmacokinetics of phenobarbital. Drug Intell Clin Pharm. 1983;17(12):901–3.

    Article  CAS  PubMed  Google Scholar 

  63. 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.

    Article  CAS  PubMed  Google Scholar 

  64. 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.

    Article  CAS  PubMed  Google Scholar 

  65. 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.

    Article  CAS  Google Scholar 

  66. White RL, Garnett WR, Allen JH, Kline BJ, Sharp DE. Phenytoin removal during plasma exchange. J Clin Apher. 1987;3(3):147–50.

    Article  CAS  PubMed  Google Scholar 

  67. Liu E, Rubenstein M. Phenytoin removal by plasmapheresis in thrombotic thrombocytopenic purpura. Clin Pharmacol Ther. 1982;31:762–5.

    Article  CAS  PubMed  Google Scholar 

  68. 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.

    Article  CAS  PubMed  Google Scholar 

  69. Silberstein LE, Shaw LM. Effect of plasma exchange on phenytoin plasma concentration. Ther Drug Monit. 1986;8(2):172–6.

    Article  CAS  PubMed  Google Scholar 

  70. Brown-Molnar CS, Bauer LA, Horn JR. Phenytoin removal by plasmapheresis in renal insufficiency. Am J Nephrol. 1986;6(4):302–6.

    Article  CAS  PubMed  Google Scholar 

  71. 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.

    Article  CAS  PubMed  Google Scholar 

  72. 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.

    CAS  PubMed  Google Scholar 

  73. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  74. 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.

    Article  CAS  PubMed  Google Scholar 

  75. 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.

    Article  CAS  PubMed  Google Scholar 

  76. 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.

    Article  CAS  PubMed  Google Scholar 

  77. 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.

    Article  PubMed  Google Scholar 

  78. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  79. 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.

    Article  CAS  PubMed  Google Scholar 

  80. 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.

    Article  PubMed  Google Scholar 

  81. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Russell DC, Paton L, Douglas AC. Amiodarone associated alveolitis and polyarthropathy. Treatment by plasma exchange. Br Heart J. 1983;50(5):491–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Chudow M, Ferguson K. A case of severe, refractory hypotension after amlodipine overdose. Cardiovasc Toxicol. 2018;18(2):192–7.

    Article  PubMed  Google Scholar 

  84. 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.

    Article  CAS  PubMed  Google Scholar 

  85. 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.

    Article  PubMed  Google Scholar 

  86. 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.

    Article  PubMed  Google Scholar 

  87. 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.

    Article  CAS  PubMed  Google Scholar 

  88. 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.

    Article  CAS  PubMed  Google Scholar 

  89. Coltart DJ, Watson D, Howard MR. Effect of exchange transfusions on plasma digoxin levels. Arch Dis Child. 1972;47(255):814–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Rosegger H, Zach M, Gleispach H, Beitzke A. Digoxin elimination by exchange transfusion. Eur J Pediatr. 1977;124(3):217–22.

    Article  CAS  PubMed  Google Scholar 

  91. 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.

    CAS  PubMed  Google Scholar 

  92. Gutschmidt HJ. Successful plasmapheresis in severe diltiazem poisoning. Dtsch Med Wochenschr. 1995;120(3):81–2.

    CAS  PubMed  Google Scholar 

  93. Martin SG, Kearns GL, Brod M, Austin G, Vaughan BC. Impact of plasmapheresis on disopyramide elimination. Pediatr Nephrol. 1999;13(4):323–5.

    Article  CAS  PubMed  Google Scholar 

  94. Evers J, Messer W, Aboudan F, Finke K. Mexiletine in terminal renal failure and various dialysis procedures. Klin Wochenschr. 1989;67(19):995–8.

    Article  CAS  PubMed  Google Scholar 

  95. 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.

    Article  Google Scholar 

  96. 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.

    Article  PubMed  Google Scholar 

  97. Talbert RL, Wong YY, Duncan DB. Propranolol plasma concentrations and plasmapheresis. Drug Intell Clin Pharm. 1981;15(12):993–6.

    Article  CAS  PubMed  Google Scholar 

  98. 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.

    Article  CAS  PubMed  Google Scholar 

  99. Siebenlist D. Plasma separation in verapamil poisoning. Dtsch Med Wochenschr. 1990;115(20):797.

    CAS  PubMed  Google Scholar 

  100. 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.

    Article  CAS  Google Scholar 

  101. Okechukwu CN, Meier-Kriesche HU, Armstrong D, et al. Removal of basiliximab by plasmapheresis. Am J Kidney Dis. 2001;37(1):E11.

    Article  CAS  PubMed  Google Scholar 

  102. 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.

    Article  PubMed  Google Scholar 

  103. Chu G, Mantin R, Shen YM, et al. Massive cisplatin overdose by accidental substitution for carboplatin. Toxicity and management. Cancer. 1993;72:3707–14.

    Article  CAS  PubMed  Google Scholar 

  104. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Jung HK, Lee J, Lee SN. A case of massive cisplatin overdose managed by plasmapheresis. Korean J Intern Med. 1995;10:150–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. 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.

    Article  CAS  PubMed  Google Scholar 

  107. 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.

    Article  PubMed  Google Scholar 

  108. Chan GL, Hodge EE. Effect of plasmapheresis on cyclosporine pharmacokinetics. DICP. 1991;25(2):211.

    Article  CAS  PubMed  Google Scholar 

  109. 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.

    Article  Google Scholar 

  110. Leitner GC, Hiesmayr M, Hoecker P, Jilma B. Therapeutic approaches in the management of oral cyclosporine a intoxication. Transplantation. 2003;75(10):1764–5.

    Article  PubMed  Google Scholar 

  111. 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.

    Article  PubMed  Google Scholar 

  112. 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.

    Article  CAS  PubMed  Google Scholar 

  113. 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.

    Article  CAS  PubMed  Google Scholar 

  114. Maldonado AQ, Davies NM, Crow SA, et al. Effects of plasmapheresis on mycophenolic acid concentrations. Transplantation. 2011;91(1):e3–4.

    Article  CAS  PubMed  Google Scholar 

  115. 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.

    Article  PubMed  Google Scholar 

  116. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Stigelman WH Jr, Henry DH, Talbert RL, Townsend RJ. Removal of prednisone and prednisolone by plasma exchange. Clin Pharm. 1984;3(4):402–7.

    PubMed  Google Scholar 

  118. 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.

    Google Scholar 

  119. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  121. 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.

    Article  CAS  PubMed  Google Scholar 

  122. 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.

    Article  PubMed  Google Scholar 

  123. 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.

    Article  CAS  Google Scholar 

  124. Przepiorka D, Suzuki J, Ippoliti C, Hester JP, Fritsche HA. Blood tacrolimus concentration unchanged by plasmapheresis. Am J Hosp Pharm. 1994;51(13):1708.

    CAS  PubMed  Google Scholar 

  125. Kosmidis HV, Bouhoutsou DO, Varvoutsi MC, et al. Vincristine overdose: experience with 3 patients. Pediatr Hematol Oncol. 1991;8(2):171–8.

    Article  CAS  PubMed  Google Scholar 

  126. Pierga JY, Beuzeboc P, Dorval T, et al. Favourable outcome after plasmapheresis for vincristine overdose. Lancet. 1992;340:185.

    Article  CAS  PubMed  Google Scholar 

  127. 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.

    Article  CAS  PubMed  Google Scholar 

  128. 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.

    Article  PubMed  Google Scholar 

  129. 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.

    PubMed  Google Scholar 

  130. 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.

    Article  PubMed  Google Scholar 

  131. 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.

    Article  PubMed  Google Scholar 

  132. Kolsal E, Tekin IO, Piskin E, et al. Treatment of severe amitriptyline intoxication with plasmapheresis. J Clin Apher. 2009;24(1):21–4.

    Article  PubMed  Google Scholar 

  133. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  134. 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.

    CAS  PubMed  Google Scholar 

  135. 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.

    Article  CAS  PubMed  Google Scholar 

  136. Laussen P, Shann F, Butt W, Tibballs J. Use of plasmapheresis in acute theophylline toxicity. Crit Care Med. 1991;19(2):288–90.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Janice Kung, Librarian at John W. Scott Library, for assisting with the keywords’ selection and search strategy.

Funding

There is no funding associated with this work.

Author information

Authors and Affiliations

Authors

Contributions

SHM and TH designed the study. MEDLINE and EMBASE search and data extraction were conducted by EC and confirmed by JB and SHM. Additionally, TH and SC conducted MEDLINE and PubMed search and data extraction, independent from the other search. All authors wrote and revised the manuscript.

Corresponding author

Correspondence to Sherif Hanafy Mahmoud.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest

Ethics approval and Informed Consent

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of work, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-020-00989-1

Keywords

Navigation