{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T08:22:02Z","timestamp":1787559722080,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Catalan Society of Clinical Pharmacy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Background: Isavuconazole, a broad-spectrum triazole antifungal, exhibits high lipophilicity and extensive plasma protein binding, properties that may predispose it to sequestration within extracorporeal membrane oxygenation (ECMO) circuits. This study aimed to characterize the pharmacokinetics (PK) of isavuconazole and to evaluate drug sequestration within the ECMO circuit in critically ill patients receiving ECMO support. Methods: We conducted a prospective, exploratory, single-center observational study including critically ill patients receiving ECMO (veno-venous (VV) or veno-arterial (VA)) and treated with intravenous isavuconazole. Serial blood samples were collected simultaneously from the patient\u2019s arterial line and from pre- and post-membrane oxygenator sampling sites. Non-compartmental analysis was performed on arterial line samples to estimate PK measures, and concentration differences across sampling sites were analyzed to estimate circuit-related drug loss. PK\/pharmacodynamic (PD) target attainment was assessed using established efficacy thresholds (AUC0\u201324\/MIC \u2265 25 and Cmin &gt; 2 mg\/L). Results: A total of 41 plasma samples from 3 critically ill patients (2 VV-ECMO, 1 VA-ECMO) were included in the analysis. Limited, component-specific isavuconazole loss was observed in tubing and connectors (6.62% \u00b1 20.8%, p = 0.294) and across the entire ECMO circuit (7.74% \u00b1 20.2%, p = 0.211). Likewise, no relevant concentration difference was detected across the membrane oxygenator (0.849% \u00b1 6.15%, p = 0.642). Interindividual variability was observed across PK parameters, particularly in measures of elimination and distribution. All patients achieved predefined PK\/PD efficacy targets, with mean Cmin and AUC0\u201324\/MIC of 3.07 \u00b1 0.261 mg\/L and 85.3 \u00b1 4.03, respectively, and none exceeded the established toxicity threshold. Conclusions: Preliminary results showed variable concentration differences across ECMO sampling sites, with no consistent pattern of isavuconazole loss across the ECMO circuit under the conditions evaluated. All patients achieved predefined PK\/PD efficacy targets using currently recommended dosing regimens; however, interindividual PK variability was observed, supporting the potential value of therapeutic drug monitoring (TDM) to guide individualized dosing decisions in this population. Larger population PK studies are warranted to further characterize determinants of isavuconazole exposure during ECMO support and refine evidence-based dosing strategies.<\/jats:p>","DOI":"10.3390\/pharmaceutics18091049","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T08:03:41Z","timestamp":1787558621000},"page":"1049","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacokinetics of Isavuconazole in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation (ECMO) Support: A Prospective Exploratory Observational Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1619-4287","authenticated-orcid":false,"given":"Alba","family":"Escol\u00e0-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Pharmacy Department, Division of Medicines, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4242-5133","authenticated-orcid":false,"given":"Elena","family":"Sandoval","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9504-7511","authenticated-orcid":false,"given":"Jorge","family":"Mois\u00e9s","sequence":"additional","affiliation":[{"name":"Respiratory Intensive and Intermediate Care Unit, Department of Respiratory Medicine, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3502-5999","authenticated-orcid":false,"given":"Adri\u00e1n","family":"T\u00e9llez Santoyo","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Medical Intensive Care Unit, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Carrami\u00f1ana","sequence":"additional","affiliation":[{"name":"Surgical-Trauma Intensive Care Unit, Department of Anesthesiology and Critical Care, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2540-2578","authenticated-orcid":false,"given":"Jaime I.","family":"Sainz de Medrano","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Genetics, Pharmacology and Toxicology Unit, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Genetics, Pharmacology and Toxicology Unit, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Roca","sequence":"additional","affiliation":[{"name":"Acute Cardiac Care Section, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9991-1127","authenticated-orcid":false,"given":"Marta","family":"Hern\u00e1ndez Meneses","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5057-354X","authenticated-orcid":false,"given":"Sabina","family":"Herrera","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merc\u00e8","family":"Brunet Serra","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Biochemistry and Molecular Genetics, Pharmacology and Toxicology Unit, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6118-8970","authenticated-orcid":false,"given":"Pedro","family":"Castro","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Medical Intensive Care Unit, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8128-345X","authenticated-orcid":false,"given":"Dolors","family":"Soy Muner","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Division of Medicines, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Departament de Farmacologia, Toxicologia i Qu\u00edmica Terap\u00e8utica, Facultat de Farm\u00e0cia i Ci\u00e8ncies de l\u2019Alimentaci\u00f3, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0845-8107","authenticated-orcid":false,"given":"Carla","family":"Bastida","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Division of Medicines, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Departament de Farmacologia, Toxicologia i Qu\u00edmica Terap\u00e8utica, Facultat de Farm\u00e0cia i Ci\u00e8ncies de l\u2019Alimentaci\u00f3, Universitat de Barcelona, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1016\/j.clinthera.2016.07.169","article-title":"Pharmacokinetics and Dosing of Anti-Infective Drugs in Patients on Extracorporeal Membrane Oxygenation: A Review of the Current Literature","volume":"38","author":"Sherwin","year":"2016","journal-title":"Clin. 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