The utility of therapeutic plasma exchange for amphotericin B overdose

Monroig-Bosque, Paloma del C.; Balk, Jonathan; Segura, Francisco; Salazar, Eric; Leveque, Christopher; Ipe, Tina S.

doi:10.1016/j.transci.2018.09.015

Cited by 10 publications

(11 citation statements)

References 11 publications

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“…A PubMed search using the terms 'amphotericin B' and 'overdose' revealed nine case reports with 11 pediatric and four adult patients (Table 1). [3][4][5][6][9][10][11][12][13] The case reports demonstrate a high mortality rate: only five patients survived the overdose. Of the adult patients, two case reports documented fatal outcomes without plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

“…In adult patients, four case reports have been documented where the non-lipid formulation was erroneously administered instead of the intended liposomal formulation. [3][4][5][6] Among these cases, only two report nonlethal outcomes in patients treated with plasmapheresis. However, these reports lack critical data on amphotericin B pharmacokinetics pre-and post-plasmapheresis.…”

mentioning

confidence: 99%

“…However, these reports lack critical data on amphotericin B pharmacokinetics pre-and post-plasmapheresis. 5,6 We present data of amphotericin B pharmacokinetics after an accidental overdose with non-lipid amphotericin DOC 5 mg/kg instead of L-AmB 5 mg/kg in a critically ill patient. Furthermore, we report information on serum levels of amphotericin B before and after plasmapheresis, adding to the body of evidence with regard to the pharmacokinetics of amphotericin B.…”

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confidence: 99%

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Pharmacokinetics of amphotericin B after accidental overdose in an adult critically ill patient treated with plasmapheresis: a case report and review of literature

Van Oers,

Workum,

Voorzaat

et al. 2024

Int J Basic Clin Pharmacol

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Amphotericin B is a broad-spectrum antifungal agent that is used in the treatment of systemic fungal infections. We describe the case of a 62-year-old female patient with recent aneurysmal subarachnoid hemorrhage who was treated for suspected ventriculitis and a fungal coinfection. Instead of liposomal amphotericin B (L-AmB), 465 mg (5 mg/kg) amphotericin B deoxycholate (DOC) was inadvertently administered, leading to refractory shock with multiple organ failure and requiring mechanical ventilation. Since an overdose of amphotericin B can lead to fatal consequences and has a half-life of 15 days, plasmapheresis was started. The serum concentration decreased from 1.32 µg/mL to 0.62 µg/mL before plasmapheresis, demonstrating a mean half-life of 49 hours. After two plasmapheresis sessions, the serum concentration further dropped to 0.26 µg/mL, demonstrating a mean half-life of 17 hours. In contrast, the third plasmapheresis session had no effect on serum concentration. The patient made a full recovery, potentially facilitated by enhanced amphotericin B elimination through plasmapheresis. Positive outcomes were previously reported in two adult patients treated with plasmapheresis. However, other reports without plasmapheresis described fatal outcomes in adult patients, albeit with a twofold overdose compared to the two patients successfully treated with plasmapheresis. Moreover, plasmapheresis itself carries risks such as hypocalcemia, metabolic alkalosis, and coagulation deficits. Consequently, the role of plasmapheresis in amphotericin B overdose is still debated.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Pharmacokinetics of amphotericin B after accidental overdose in an adult critically ill patient treated with plasmapheresis: a case report and review of literature

Van Oers,

Workum,

Voorzaat

et al. 2024

Int J Basic Clin Pharmacol

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“…The importance of user instructions is emphasized by serious and sometimes fatal cases as e.g. accidental swapping of conventional and liposomal amphotericin formulations 47–49 or swapping daily and weekly dosing regimens of methotrexate 50,51 . This indicates that users may not have adequate understanding of some drug delivery approaches and that this would require specific risk mitigation measures in the drug product design such as the package label.…”

Section: Discussionmentioning

confidence: 99%

Opportunities for changes in the drug product design to enhance medication safety in older people: Evaluation of a national public portal for medication incidents

Karapinar-Çarkıt

Bemt

Sadik

et al. 2020

Brit J Clinical Pharma

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Aims Medication safety requires urgent attention in hospital pharmacy. This study evaluated the medication‐related problems/errors as reported to the Dutch medication incident registry and disseminated for information to pharmacists. Through analysis by an expert panel we aimed to better understand which problems could have been mitigated by the drug product design. Additionally, the (wider) implications of the problems for current hospital/clinical practice were discussed. Methods Items were extracted from the public Portal for Patient Safety. Items were included if relevant for older people and connected with the drug product design and excluded if they should reasonably have been intercepted by compliance to routine controls or well‐known professional standards in pharmaceutical care. To explore any underreporting of well‐known incidents, it was investigated if different medication‐related problems could be observed in a regional hospital practise over a 1‐month period. For 6 included items (cases), the implications for hospital/clinical practise were discussed in an expert panel. Results In total, 307 items were identified in the Portal for Patient Safety; all but 14 were excluded. Six cases were added from daily hospital practice. These 20 cases commonly related to confusing product characteristics, packaging issues such as the lack of a single unit package for an oncolytic product, or incorrect or incomplete user instructions. Conclusion Medication registries provide important opportunities to evaluate real‐world medication‐related problems. However, underreporting of well‐known problems should be considered. The product design can be used as an (additional) risk mitigation measure to support medication safety in hospital practice.

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“…To measure in vitro toxicity, we investigated whether the nanocomplexes previously obtained displayed lytic activity towards canine red blood cells (RBCs) since, as outlined in the literature, hemolysis is a severe side effect of AmB. 70 Amphotericin B was the most toxic formulation for the canine RBCs at almost all tested doses (2, 4, 8, 16 and 32 µM), promoting a hemolysis rate between 13.4-83.6% (Fig. 7).…”

Section: Papermentioning

confidence: 99%

Hyaluronic acid–amphotericin B nanocomplexes: a promising anti-leishmanial drug delivery system

et al. 2022

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The utility of therapeutic plasma exchange for amphotericin B overdose

Cited by 10 publications

References 11 publications

Pharmacokinetics of amphotericin B after accidental overdose in an adult critically ill patient treated with plasmapheresis: a case report and review of literature

Pharmacokinetics of amphotericin B after accidental overdose in an adult critically ill patient treated with plasmapheresis: a case report and review of literature

Opportunities for changes in the drug product design to enhance medication safety in older people: Evaluation of a national public portal for medication incidents

Hyaluronic acid–amphotericin B nanocomplexes: a promising anti-leishmanial drug delivery system

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