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Pharmacokinetics of teicoplanin during plasma exchange
Patrice Alet1, Olivier Lortholary, Francis Fauvelle
1Départment de Pharmacologie-Toxicologie.
Abstract:
OBJECTIVE: To study the elimination of teicoplanin during plasma exchange, a procedure currently used to treat a variety of disorders involving immune complexes. Teicoplanin is a glycopeptide antibiotic that exhibits a long terminal half-life (100-150 h) and is highly bound to plasma proteins (unbound fraction (fu)=0.2). METHODS: Twelve adults with systemic polyarteritis nodosa, cryoglobulinemia-induced vasculitis or dysglobulinemic neuropathy undergoing plasma exchange were studied. Each patient received intravenous teicoplanin, 6 mg/kg body weight, immediately before plasma exchange. Plasma was assayed for teicoplanin by high pressure liquid chromatography. RESULTS: A high level of protein binding of teicoplanin was measured within this patient population (98%). The mean quantity of teicoplanin eliminated (+/-SD) was 74.6+/-34.6 mg. The mean drug fraction eliminated by plasma exchange (+/-SD) was 19.5+/-5.6%. Mean fu value as determined by ultrafiltration (+/-SD) was 2.2+/-1.7%. CONCLUSIONS: These results show that plasma exchange influences teicoplanin pharmacokinetics, with a clinically significant quantity being eliminated. If trough teicoplanin concentrations of around 10 mg/L are desired, it is recommended that teicoplanin dosage be supplemented or given after plasma exchange.
Insights
Plasma exchange significantly eliminates teicoplanin, a potent antibiotic. Dosage adjustments are recommended post-procedure to maintain effective teicoplanin levels for patients undergoing this treatment.
Area of Science:
- Pharmacology
- Nephrology
- Immunology
Background:
- Teicoplanin is a glycopeptide antibiotic with a long half-life (100-150 hours) and high plasma protein binding (unbound fraction [fu]=0.2).
- Plasma exchange is a therapeutic procedure used for various immune complex-related disorders.
Purpose of the Study:
- To investigate the elimination of teicoplanin during plasma exchange.
- To understand the impact of plasma exchange on teicoplanin pharmacokinetics.
Main Methods:
- Twelve adult patients undergoing plasma exchange for systemic polyarteritis nodosa, cryoglobulinemia-induced vasculitis, or dysglobulinemic neuropathy were studied.
- Teicoplanin (6 mg/kg) was administered intravenously before plasma exchange.
- Plasma teicoplanin levels were quantified using high-pressure liquid chromatography.
Main Results:
- Teicoplanin exhibited high protein binding (98%) in this patient cohort.
- Plasma exchange eliminated a mean quantity of 74.6 mg of teicoplanin.
- The mean fraction of teicoplanin eliminated was 19.5%, with a mean unbound fraction (fu) of 2.2%.
Conclusions:
- Plasma exchange significantly alters teicoplanin pharmacokinetics.
- A clinically relevant amount of teicoplanin is removed during plasma exchange.
- Supplementing teicoplanin dosage or administering it after plasma exchange is advised to achieve target trough concentrations of approximately 10 mg/L.