CYCLOSPORINE AND VANCOMYCIN DISPOSITION DURING CONTINUOUS VENOVENOUS HEMODIAFILTRATION

OBJECTIVE: To report cyclosporine and vancomycin disposition during co ntinuous venovenous hemodiafiltration (CVVHD) in a 41-year-old heart t ransplant patient while in the intensive care unit at a primary and te rtiary care teaching hospital. CASE SUMMARY: The patient received a 60 -mg infusion of cyclosporine over 24 hours and vancomycin 1 g over 1 h our. Blood samples subsequently were collected and analyzed using whol e blood monoclonal radioimmunoassay and fluorescence polarization immu noassay, respectively. Blood samples were measured every hour from the arterial and venous lines of the apparatus, as were ultrafiltrate dru g concentrations. Drug clearance rates into the ultrafiltrate subseque ntly were calculated. DISCUSSION: Measurements of ultrafiltrate detect ed no cyclosporine. A slight variation existed between arterial and ve nous drug concentrations, which was not statistically significant (p > 0.05, paired Student's t-test). Analysis of vancomycin samples reveal ed a steady decline of drug concentration, with 4.75% of the dose elim inated in the ultrafiltrate, Vancomycin arterial and venous concentrat ions decreased from 24.4 and 23.3 mg/L to 15.7 and 12.3 mg/L, respecti vely. CONCLUSIONS: Vancomycin is eliminated by CVVHD and it may be nec essary for these patients to receive the drug more frequently. In cont rast, cyclosporine is not removed effectively by CVVHD; therefore, rep lacement doses are not warranted.