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Interaction of azithromycin and methylprednisolone with ex-vivo extracorporeal membrane oxygenation circuits (ECMO)
Andrew Chevalier1, Autumn McKnite2, Aviva Whelan1
1Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Abstract:
BackgroundAzithromycin and methylprednisolone are two medications that are commonly used in patients who require ECMO support. Unfortunately, ECMO support can decrease drug concentrations through adsorption to circuit components. Such interactions have not been well described for either azithromycin or methylprednisolone. This study determined the extraction of these medications by ECMO circuits in an ex-vivo system.MethodsMedications were administered to closed-loop, blood-primed ECMO circuits to attain target therapeutic concentrations. Drug concentration remaining in the circuit was measured over 6 h. The difference in medication recovery was compared between the ECMO circuits and controls using two-sample t-tests.ResultsConcentrations of azithromycin and methylprednisolone remained constant in control experiments over time, indicating medication stability in blood. There was no statistical difference in percent recovery after 6 h between control experiments and the ECMO circuits for either azithromycin (p = .32) or methylprednisolone (p = .17).DiscussionAzithromycin and methylprednisolone did not significantly interact with ex-vivo ECMO circuits. While these studies do not account for all in-vivo pharmacokinetic changes that may occur as a result of ECMO and critical illness, they suggest that standard dosing may be adequate to achieve therapeutic concentrations of azithromycin and methylprednisolone.
Insights
Azithromycin and methylprednisolone do not significantly interact with extracorporeal membrane oxygenation (ECMO) circuits. This suggests standard drug doses may be sufficient for patients requiring ECMO support.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients.
- Drug adsorption to ECMO circuits can alter medication concentrations.
- Interactions of azithromycin and methylprednisolone with ECMO circuits are not well-described.
Purpose of the Study:
- To determine the extent of azithromycin and methylprednisolone extraction by ECMO circuits.
- To evaluate potential drug-circuit interactions in an ex-vivo model.
Main Methods:
- Azithromycin and methylprednisolone were administered to blood-primed ECMO circuits.
- Drug concentrations were measured over 6 hours in ECMO circuits and controls.
- Statistical analysis (two-sample t-tests) compared medication recovery.
Main Results:
- Medication concentrations remained stable in control experiments, confirming drug stability.
- No statistically significant difference in percent recovery was observed for azithromycin or methylprednisolone between ECMO circuits and controls after 6 hours.
- p-values for azithromycin and methylprednisolone were 0.32 and 0.17, respectively.
Conclusions:
- Azithromycin and methylprednisolone show no significant interaction with ex-vivo ECMO circuits.
- Standard dosing of these medications may be adequate for patients on ECMO.
- Further in-vivo studies are needed to account for all pharmacokinetic changes.
