Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report
Background: Isavuconazole is an azole antifungal with extended activity against yeast and molds. It is highly lipophilic, largely protein bound, and has a large volume of distribution. Critically ill patients exhibit altered pharmacokinetics (PK) of antimicrobials due to physiologic changes and oth...
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University of Minnesota Libraries Publishing
2025-07-01
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| Series: | INNOVATIONS in Pharmacy |
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| Online Access: | https://pubs.lib.umn.edu/index.php/innovations/article/view/6563 |
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| author | Blain Thayer Taylor D Steuber Alexandria Rydz Jenna Fleming Justin Sorenson Michael Arnold Taylor Nelson |
| author_facet | Blain Thayer Taylor D Steuber Alexandria Rydz Jenna Fleming Justin Sorenson Michael Arnold Taylor Nelson |
| author_sort | Blain Thayer |
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Background: Isavuconazole is an azole antifungal with extended activity against yeast and molds. It is highly lipophilic, largely protein bound, and has a large volume of distribution. Critically ill patients exhibit altered pharmacokinetics (PK) of antimicrobials due to physiologic changes and other organ support modalities, including extracorporeal membrane oxygenation (ECMO). Azole antifungals, including isavuconazole, are prone to significant reduction in serum concentrations during ECMO support as a result of sequestration in the circuit and mechanical destruction of the drug via centrifugal pump, often necessitating therapeutic drug monitoring (TDM). Herein, we report a case of a young male treated for suspected invasive pulmonary aspergillosis who was placed on ECMO and treated with isavuconazole. Despite escalating doses and intense TDM, therapeutic concentrations were unable to be achieved. The patient was switched to voriconazole and liposomal amphotericin B. The patient achieved clinical improvement and switched back to isavuconazole to complete a 12-week course after ECMO decannulation occurred. This case highlights the importance of isavuconazole TDM, especially during ECMO, and consideration of alternative agents if necessary.
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| format | Article |
| id | doaj-art-36031a3f51bc4145954829dcabcf4b37 |
| institution | Kabale University |
| issn | 2155-0417 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | University of Minnesota Libraries Publishing |
| record_format | Article |
| series | INNOVATIONS in Pharmacy |
| spelling | doaj-art-36031a3f51bc4145954829dcabcf4b372025-08-20T04:01:03ZengUniversity of Minnesota Libraries PublishingINNOVATIONS in Pharmacy2155-04172025-07-0116210.24926/iip.v16i2.6563Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case ReportBlain Thayer0Taylor D Steuber1Alexandria Rydz2Jenna Fleming3Justin Sorenson4Michael Arnold5Taylor Nelson6University Hospital, Columbia, MOUniversity of Missouri - Kansas City School of PharmacyUniversity Hospital, Columbia, MOUniversity Hospital, Columbia, MOUniversity Hospital, Columbia, MOUniversity Hospital, Columbia, MOUniversity of Missouri School of Medicine, Columbia, MO Background: Isavuconazole is an azole antifungal with extended activity against yeast and molds. It is highly lipophilic, largely protein bound, and has a large volume of distribution. Critically ill patients exhibit altered pharmacokinetics (PK) of antimicrobials due to physiologic changes and other organ support modalities, including extracorporeal membrane oxygenation (ECMO). Azole antifungals, including isavuconazole, are prone to significant reduction in serum concentrations during ECMO support as a result of sequestration in the circuit and mechanical destruction of the drug via centrifugal pump, often necessitating therapeutic drug monitoring (TDM). Herein, we report a case of a young male treated for suspected invasive pulmonary aspergillosis who was placed on ECMO and treated with isavuconazole. Despite escalating doses and intense TDM, therapeutic concentrations were unable to be achieved. The patient was switched to voriconazole and liposomal amphotericin B. The patient achieved clinical improvement and switched back to isavuconazole to complete a 12-week course after ECMO decannulation occurred. This case highlights the importance of isavuconazole TDM, especially during ECMO, and consideration of alternative agents if necessary. https://pubs.lib.umn.edu/index.php/innovations/article/view/6563isavuconazoleisavuconazonium sulfatetherapeutic drug monitoringextracorporeal membrane oxygenation |
| spellingShingle | Blain Thayer Taylor D Steuber Alexandria Rydz Jenna Fleming Justin Sorenson Michael Arnold Taylor Nelson Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report INNOVATIONS in Pharmacy isavuconazole isavuconazonium sulfate therapeutic drug monitoring extracorporeal membrane oxygenation |
| title | Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report |
| title_full | Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report |
| title_fullStr | Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report |
| title_full_unstemmed | Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report |
| title_short | Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report |
| title_sort | navigating therapeutic drug monitoring of isavuconazole in invasive mold infection on extracorporeal membrane oxygenation a case report |
| topic | isavuconazole isavuconazonium sulfate therapeutic drug monitoring extracorporeal membrane oxygenation |
| url | https://pubs.lib.umn.edu/index.php/innovations/article/view/6563 |
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