PharmPK Discussion - Drug use in CVVH and CVVHD

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On 19 Mar 1997 at 22:09:49, Estelle (estelle.aaa.md.huji.ac.il) sent the message


Does anyone know where I can get hold of information on the use of drugs in
CVVH and CVVHD? i.e. which drugs need their doses to be compensated for
because of removal into the ultrafiltrate etc?
I especially need information re allopurinol.

Thanks
Estelle Smith
Paediatric Pharmacist
Shaare Zedek Hospital
Jerusalem,Israel
estelle.-a-.md2.huji.ac.il

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On 20 Mar 1997 at 09:28:16, Alison Thomson (athomson.-a-.clinmed.gla.ac.uk) sent the message


Here are some general reviews on the topic:

Reetze-Bonorden et al, Drug dosage in patients during continuous
renal replacement therapy.  Clinical Pharmacokinetics 24 (5) 362 - 379,
1995

Bressolle et al, Clinical pharmacokinetics during continuous
haemofiltration. Clinical Pharmacokinetics 26 (6) 457 - 471, 1994.

Bickley SK, Drug dosing during continuous arteriovenous hemofiltration.
Clinical Pharmacy 7: 198 - 206, 1988.

Schetz et al, Pharmacokinetics of continuous renal replacement
therapy. Intensive Care Medicine 21: 612 - 620, 1995.

Cotterill S, Antimicrobial prescribing in patients on haemofiltration.
Journal of Antimicrobial Chemotherapy 36: 773 - 780, 1995.

I'm not sure you will find anything on allopurinol but they might help
you predict the likely effects.
Alison Thomson

Clinical Pharmacokinetics & Biometrics Unit
Dept of Medicine & Therapeutics
West Glasgow Hospitals Trust
Glasgow G11 6NT
Tel  #44 141 211 2022
Fax  #44 141 339 2800
Email A.H.Thomson.aaa.clinmed.gla.ac.uk

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On 21 Mar 1997 at 10:34:36, "Randy Trinkle" (rtrinkle.aaa.pris.bc.ca) sent the message


Try

Reetze-Boroden P, Bohler J, Keller E. Drug dosage in patients
during continuous renal replacement therapy: pharmacokinetic and therapeutic
considerations. Clin Pharmacokinet 1993;24:362-379.

This is an extensive review of published data includes a table of
suggested dosage adjustments for a large number of drugs.

********************************
Randy Trinkle, BScPharm, BA
Dept. of Pharmacy
Dawson Creek & District Hospital
Dawson Creek, BC
mailto://rtrinkle.at.pris.bc.ca
********************************

Every now and then when your life gets complicated...
                                               HST

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On 23 Mar 1997 at 11:09:41, William Dager (wedager.at.ucdavis.edu) sent the message


We recently had a patient post chemotherapy who developed acute renal
failure. The allopurinol dose was 600mg/day.  In our CVVH patients, we
use a f-40 filter with convection rates of 1 l/hr and blood flows of 170
ml/min. We have measured aminoglycoside clearance rates of approx 25
ml/min. Using this as a guide, and that allopurinol is dialyzable, we
made a emperic dose reduction of 50 % and followed uric acid levels. The
uric acid had dropped from 15.2 to 10.5 at the time cvvh was started.
300mg/day was given during cvvh for 2 days. The uric acid was 3.7 at that
time. Both cvvh and allopurinol were stopped after 2 days and the uric
acid level 3 days later stabilized at 8.7.

Hope this helps you.

William Dager, Pharm.D.,FCSHP
Coordinator, Pharmacokinetic Consult Service
UC Davis Medical Center   > > >

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