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Flucloxacilline bij verminderde nierfunctie en hypoalbuminemie: therapeutic drug monitoring noodzakelijk?

Kempers, R., Wangsawirana, V., Betlehem, C., Touw, D. & Brinkman, I., 4-Jul-2016, In : Pharmaceutische Weekblad Wetenschappelijk Platform. 2016;1:a1621.

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  • Richard Kempers
  • Valesca Wangsawirana
  • Carina Betlehem
  • Daniël Touw
  • Ithamar Brinkman
Altered pharmacokinetics and pharmacodynamics are common among critically ill patients. This case report describes a burn patient suffering from renal insufficiency and hypoalbuminaemia due to his critical condition. Hypoalbuminaemia can result in decreased protein binding of drugs, which can lead to altered pharmacokinetics and pharmacodynamics. This is especially relevant for drugs with strong protein binding or hydrophilic drugs. In this case, hypoalbuminaemia in combination with renal insufficiency led to a threefold increase in the concentration of unbound flucloxacillin. These high blood levels are a risk factor for side-effects and may be potentially toxic for the patient. High doses of flucloxacillin in combination with renal insufficiency can cause neurological side-effects, such as convulsions. After therapeutic drug monitoring (TDM) dose adjustments were made, with good result. TDM of unbound flucloxacillin might be essential for optimizing the individual therapy of patients with renal insufficiency and hypoalbuminaemia.
Original languageDutch
Article number2016;1:a1621
JournalPharmaceutische Weekblad Wetenschappelijk Platform
Publication statusPublished - 4-Jul-2016

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