PDF
Published
2025-07-29
Issue
Section
Pharmacy Practice & Practice-Based Research
Categories
License
Copyright (c) 2025 Blain Thayer, Taylor D Steuber, Alexandria Rydz, Jenna Fleming, Justin Sorenson, Michael Arnold, Taylor Nelson
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of content published in INNOVATIONS in pharmacy belongs to the author(s).
Navigating Therapeutic drug monitoring of Isavuconazole in Invasive Mold Infection on Extracorporeal membrane oxygenation - A Case Report
Blain Thayer
University Hospital, Columbia, MO
https://orcid.org/0009-0004-7164-6068
Taylor D Steuber
University of Missouri - Kansas City School of Pharmacy
https://orcid.org/0000-0002-7656-1504
Alexandria Rydz
University Hospital, Columbia, MO
Jenna Fleming
University Hospital, Columbia, MO
https://orcid.org/0000-0001-8090-1949
Justin Sorenson
University Hospital, Columbia, MO
Michael Arnold
University Hospital, Columbia, MO
Taylor Nelson
University of Missouri School of Medicine, Columbia, MO
https://orcid.org/0000-0003-1913-9304
DOI: https://doi.org/10.24926/iip.v16i2.6563
Keywords: isavuconazole, isavuconazonium sulfate, therapeutic drug monitoring, extracorporeal membrane oxygenation
Abstract
Background: Isavuconazole is an azole antifungal with extended activity against yeast and molds. It is highly lipophilic, largely protein bound, and has a large volume of distribution. Critically ill patients exhibit altered pharmacokinetics (PK) of antimicrobials due to physiologic changes and other organ support modalities, including extracorporeal membrane oxygenation (ECMO). Azole antifungals, including isavuconazole, are prone to significant reduction in serum concentrations during ECMO support as a result of sequestration in the circuit and mechanical destruction of the drug via centrifugal pump, often necessitating therapeutic drug monitoring (TDM). Herein, we report a case of a young male treated for suspected invasive pulmonary aspergillosis who was placed on ECMO and treated with isavuconazole. Despite escalating doses and intense TDM, therapeutic concentrations were unable to be achieved. The patient was switched to voriconazole and liposomal amphotericin B. The patient achieved clinical improvement and switched back to isavuconazole to complete a 12-week course after ECMO decannulation occurred. This case highlights the importance of isavuconazole TDM, especially during ECMO, and consideration of alternative agents if necessary.
Downloads
Author Biographies
Blain Thayer, University Hospital, Columbia, MO
Department of Pharmacy
Alexandria Rydz, University Hospital, Columbia, MO
Department of Pharmacy
Jenna Fleming, University Hospital, Columbia, MO
Department of Pharmacy
Justin Sorenson, University Hospital, Columbia, MO
Department of Pharmacy
Michael Arnold, University Hospital, Columbia, MO
Department of Pharmacy
Taylor Nelson, University of Missouri School of Medicine, Columbia, MO
Department of Infectious Disease
