Voriconazole pharmacokinetics in a critically ill patient during extracorporeal membrane oxygenation

The pharmacokinetics (PK) of several drugs including antimicrobials might be highly altered during extracorporeal membrane oxygenation (ECMO) therapy. We present the change of voriconazole (VRC) PK during ECMO in a critically ill patient who received intravenous VRC at a maintenance dose of 200 mg every 12 h for empirical antifungal therapy. Two PK profiles were drawn before and after the initiation of ECMO therapy. Though the trough levels (both C₀ and C₁₂) with ECMO were slightly lower than that without ECMO (12.58 and 12.84 vs. 14.02 μg/mL), the peak levels and the area under the concentration-time curve from 0 h to 6 h (AUC_0-6) were comparable (16.36 vs. 16.06 μg/mL and 90.78 vs. 91.45 μg·h/mL, respectively), indicating that VRC plasma exposure during ECMO therapy did not greatly decrease in our patient. The circuit factors including the type of membrane should be taken into account to further identify the effects of ECMO on the PK of VRC.