{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:31:48Z","timestamp":1787592708190,"version":"build-2736575974"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"15","license":[{"start":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T00:00:00Z","timestamp":1649030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>We present the case of a 56-year-old man with stage IV sarcoidosis on veno-venous extracorporeal membrane oxygenation (VV-ECMO) support for the management of respiratory failure receiving treatment with isavuconazole for invasive aspergillosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>VV-ECMO is an increasingly utilized life support therapy for patients with cardiac and\/or respiratory failure, but its impact on medication dosing is poorly understood. In our patient with invasive Aspergillus infection receiving VV-ECMO, because of difficulty achieving therapeutic serum concentrations of voriconazole, we administered isavuconazole 372 mg intravenously (IV) every 8 hours for 6 doses followed by 372 mg IV once daily. Isavuconazole has a favorable pharmacokinetic and safety profile compared to other azole antifungal agents, but its high protein binding and lipophilicity raise concerns about drug sequestration in the VV-ECMO circuit. To optimize the efficacy and safety of this treatment, the isavuconazole trough concentration was measured at days 5 and 17, at which time it was 1.7 and 0.7 \u03bcg\/mL, respectively. The dose was subsequently increased to 744 mg IV once daily, and serum trough concentrations were measured 5 and 8 days after dose adjustment, corresponding to 3.7 and 2.9 \u03bcg\/mL, respectively. To our knowledge, this is the third report to describe inadequate isavuconazole trough concentrations during VV-ECMO support when utilizing standard doses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In the case described here, standard-dose isavuconazole (372 mg every 8 hours for 6 doses followed by 372 mg daily) did not achieve target trough concentrations in a patient receiving concomitant ECMO support.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxac043","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T14:23:08Z","timestamp":1649082188000},"page":"1245-1249","source":"Crossref","is-referenced-by-count":19,"title":["Decreased isavuconazole trough concentrations in the treatment of invasive aspergillosis in an adult patient receiving extracorporeal membrane oxygenation support"],"prefix":"10.1093","volume":"79","author":[{"given":"Michelle","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Temple University Hospital , Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geena","family":"Kludjian","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Temple University Hospital , Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Mohrien","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Temple University Hospital , Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumi","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Temple University Hospital , Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,4,4]]},"reference":[{"key":"2022072208584832700_CIT0001","doi-asserted-by":"crossref","first-page":"S629","DOI":"10.21037\/jtd.2017.09.154","article-title":"Optimising drug dosing in patients receiving extracorporeal membrane oxygenation","volume":"10","author":"Cheng","year":"2018","journal-title":"J Thorac Dis."},{"key":"2022072208584832700_CIT0002","volume-title":"Cresemba (isavuconazole). Package insert","year":"2019"},{"key":"2022072208584832700_CIT0003","article-title":"Comparison of isavuconazole and other azoles with respect to physicochemical and pharmacokinetic properties affecting tissue penetration","volume-title":"Poster presented at: ESCMID","author":"Larger"},{"issue":"1","key":"2022072208584832700_CIT0004","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1002\/phar.2348","article-title":"Altered pharmacokinetics and dosing of liposomal amphotericin B and isavuconazole during extracorporeal membrane oxygenation","volume":"40","author":"Zhao","year":"2020","journal-title":"Pharmacotherapy."},{"issue":"2","key":"2022072208584832700_CIT0005","doi-asserted-by":"crossref","first-page":"90","DOI":"10.3390\/jof6020090","article-title":"Isavuconazole treatment in a mixed patient cohort with invasive fungal infections: outcome, tolerability and clinical implications of isavuconazole plasma concentrations","volume":"6","author":"Zurl","year":"2020","journal-title":"J Fungi."},{"issue":"9","key":"2022072208584832700_CIT0006","doi-asserted-by":"crossref","first-page":"5483","DOI":"10.1128\/AAC.02819-15","article-title":"Population pharmacokinetics of isavuconazole from phase 1 and phase 3 (SECURE) trials in adults and target attainment in patients with invasive infections due to aspergillus and other filamentous fungi","volume":"60","author":"Desai","year":"2016","journal-title":"Antimicrob Agents Chemother."},{"issue":"7","key":"2022072208584832700_CIT0007","doi-asserted-by":"crossref","first-page":"e00585","DOI":"10.1128\/AAC.00585-18","article-title":"Isavuconazole concentration in real-world practice: consistency with results from clinical trials","volume":"62","author":"Andes","year":"2018","journal-title":"Antimicrob Agents Chemother."},{"issue":"7","key":"2022072208584832700_CIT0008","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1093\/mmy\/myaa022","article-title":"Lessons from isavuconazole therapeutic drug monitoring at a United Kingdom reference center","volume":"58","author":"Borman","year":"2020","journal-title":"Med Mycol."},{"issue":"6","key":"2022072208584832700_CIT0009","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1007\/s00134-007-0606-2","article-title":"Potential drug sequestration during extracorporeal membrane oxygenation: results from an ex vivo experiment","volume":"33","author":"Mehta","year":"2007","journal-title":"Intensive Care Med."},{"issue":"6","key":"2022072208584832700_CIT0010","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1177\/0267659120937906","article-title":"Oxygenator impact on voriconazole in extracorporeal membrane oxygenation circuits","volume":"35","author":"Cies","year":"2020","journal-title":"Perfusion."},{"issue":"8","key":"2022072208584832700_CIT0011","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1093\/jac\/dkz188","article-title":"Serial monitoring of isavuconazole blood levels during prolonged antifungal therapy","volume":"74","author":"Furfaro","year":"2019","journal-title":"J Antimicrob Chemother."},{"issue":"6","key":"2022072208584832700_CIT0012","doi-asserted-by":"crossref","first-page":"741.e9","DOI":"10.1016\/j.jcrc.2012.02.013","article-title":"Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation","volume":"27","author":"Shekar","year":"2012","journal-title":"J Crit Care."},{"key":"2022072208584832700_CIT0013","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1186\/s13054-015-1151-y","article-title":"Can physicochemical properties of antimicrobials be used to predict their pharmacokinetics during extracorporeal membrane oxygenation? Illustrative data from ovine models","volume":"19","author":"Shekar","year":"2015","journal-title":"Crit Care."},{"issue":"1","key":"2022072208584832700_CIT0014","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s13054-018-2285-5","article-title":"The pharmacokinetic challenge of treating invasive aspergillosis complicating severe influenzae assisted by extracorporeal membrane oxygenation","volume":"22","author":"Winiszewski","year":"2018","journal-title":"Crit Care."},{"issue":"4","key":"2022072208584832700_CIT0015","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1093\/jac\/dkp026","article-title":"Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenation","volume":"63","author":"Spriet","year":"2009","journal-title":"J Antimicrob Chemother."}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxac043\/43253904\/zxac043.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/79\/15\/1245\/45024021\/zxac043.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/79\/15\/1245\/45024021\/zxac043.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T08:59:12Z","timestamp":1658480352000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/79\/15\/1245\/6563236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,4]]},"references-count":15,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,4,4]]},"published-print":{"date-parts":[[2022,7,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxac043","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,8,1]]},"published":{"date-parts":[[2022,4,4]]}}}