Author Of 2 Presentations
PHARMACOTHERAPY DURING ECMO
THERAPEUTIC DRUG MONITORING IS ESSENTIAL FOR PHENOBARBITAL DOSING IN NEONATES ON EXTRACORPOREAL MEMBRANE OXYGENATION
Abstract
Background
Phenobarbital is a frequently used anticonvulsive drug in patients undergoing extracorporeal membrane oxygenation (ECMO). The use of ECMO is associated with significant changes in drug pharmacokinetics (PK), which may lead to insufficient or toxic effects.
Objectives
The aim of this study was to characterize PK of phenobarbital in neonates on ECMO.
Methods
Therapeutic data monitoring (TDM) data from 11 (6 female, 5 male) neonates (median (IQR), body weight (BW): 3.16 (2.63-4.02) kg; postnatal age (PNA): 8 (4-17) days, gestational age: 38.6 (38-41) weeks) treated with veno-venous or veno-arterial ECMO were available, 5 phenobarbital concentrations were determined before ECMO, 31 during ECMO and 17 concentrations after decannulation. TDM data from a control group included 50 neonates (BW: 3.3 (2.8 to 3.5) kg, PNA: 2 (1-3) days, GA: 39 (38 to 40) weeks). Population PK analysis was performed using NONMEM® version 7.3. Maturation functions based on BW and PNA for clearance (CL) and based on BW for distribution volume (Vd) were obtained from literature (1).
Results
CL values before start of ECMO were comparable to the reference population. There was a 3.5-fold increase in phenobarbital CL during ECMO compared to the reference population, with a trend towards a time-dependent increase. Furthermore, phenobarbital CL reduced 2-fold after decannulation compared to CL during ECMO. Changes in Vd with ECMO could not be identified.
Conclusion
CL is the only parameter driving steady state concentrations for phenobarbital. ECMO leads to high inter-individual variability in CL of phenobarbital, therefore TDM is essential in these patients.
Presenter of 2 Presentations
PHARMACOTHERAPY DURING ECMO
THERAPEUTIC DRUG MONITORING IS ESSENTIAL FOR PHENOBARBITAL DOSING IN NEONATES ON EXTRACORPOREAL MEMBRANE OXYGENATION
Abstract
Background
Phenobarbital is a frequently used anticonvulsive drug in patients undergoing extracorporeal membrane oxygenation (ECMO). The use of ECMO is associated with significant changes in drug pharmacokinetics (PK), which may lead to insufficient or toxic effects.
Objectives
The aim of this study was to characterize PK of phenobarbital in neonates on ECMO.
Methods
Therapeutic data monitoring (TDM) data from 11 (6 female, 5 male) neonates (median (IQR), body weight (BW): 3.16 (2.63-4.02) kg; postnatal age (PNA): 8 (4-17) days, gestational age: 38.6 (38-41) weeks) treated with veno-venous or veno-arterial ECMO were available, 5 phenobarbital concentrations were determined before ECMO, 31 during ECMO and 17 concentrations after decannulation. TDM data from a control group included 50 neonates (BW: 3.3 (2.8 to 3.5) kg, PNA: 2 (1-3) days, GA: 39 (38 to 40) weeks). Population PK analysis was performed using NONMEM® version 7.3. Maturation functions based on BW and PNA for clearance (CL) and based on BW for distribution volume (Vd) were obtained from literature (1).
Results
CL values before start of ECMO were comparable to the reference population. There was a 3.5-fold increase in phenobarbital CL during ECMO compared to the reference population, with a trend towards a time-dependent increase. Furthermore, phenobarbital CL reduced 2-fold after decannulation compared to CL during ECMO. Changes in Vd with ECMO could not be identified.
Conclusion
CL is the only parameter driving steady state concentrations for phenobarbital. ECMO leads to high inter-individual variability in CL of phenobarbital, therefore TDM is essential in these patients.