Pharmacokinetics of zanamivir in critically ill patients undergoing continuous venovenous hemofiltration

André Wieringa*, Peter G.J. ter Horst, Gert Jan HJ Wagenvoort, Birgit C.P. Koch, Jasper J. Haringman

*Corresponding author for this work

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Background: Limited data exist for dosing of zanamivir in the setting of CVVH in the intensive care unit (ICU). Our objective is to report the pharmacokinetics and sieving coefficient (Sv) of zanamivir in patients receiving continuous venovenous hemofiltration (CVVH). Methods: In this prospective observational study, patients of ≥18 years admitted to the ICU with a life-threatening Influenza A or B infection, treated with zanamivir i.v. undergoing CVVH were included. Patients received a zanamivir loading dose of 600 mg i.v., 12 h later followed by maintenance dosages two times daily according to the treating physician. Per patient, nine CFT plasma and nine ultrafiltrate samples were drawn on day 2 of treatment and analysed with a validated HPLC-MS/MS method. Results: Four patients were included in the study. The zanamivir elimination half-life was prolonged with 5.6–9.9 h, compared to patients with normal renal function. A Sv of approximately 1.0 was identified, with unrestricted transport of zanamivir to the ultrafiltrate. Conclusions: Zanamivir is well cleared by CVVH. In absence of the possibility for therapeutic drug monitoring, the ultrafiltration rate seems as a good surrogate parameter to estimate the CLCVVH and may help guide the dosing of zanamivir.

Original languageEnglish
JournalAntiviral Therapy
Issue number1
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project has received funding from the Isala Research fund. The funders approved the design of the trial, but had no role in the collection, analysis and interpretation of data or in writing manuscripts or the decision to publish.

Publisher Copyright: © The Author(s) 2023.


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