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Valganciclovir dosing using area under the curve calculations in pediatric solid organ transplant recipients
Author(s) -
Villeneuve David,
Brothers Adam,
Harvey Eric,
Kemna Mariska,
Law Yuk,
Nemeth Thomas,
Gantt Soren
Publication year - 2013
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12030
Subject(s) - dosing , valganciclovir , medicine , area under the curve , ganciclovir , pharmacokinetics , transplantation , therapeutic drug monitoring , immunology , virus , human cytomegalovirus
Pediatric valganciclovir dosing recommendations have not been extensively validated for prevention or treatment for CMV infection. As such, we performed a pharmacokinetic study to compare different valganciclovir dosing regimens and the potential benefits of individualized dose adjustments in children following organ transplantation. Ganciclovir AUC s were calculated from four plasma drug levels in pediatric SOT recipients aged six months through three yr receiving valganciclovir suspension by mouth. Of the 28 ganciclovir AUC calculations performed, 11 (39%) were outside the therapeutic target range of 40–60 mcg h/L leading to a valganciclovir dose adjustment. Current manufacturer‐recommended dosing based on BSA and C r Cl was estimated to result in therapeutic AUC s in fewer patients than the simple weight‐based formula used in our institution (4 vs. 13; p = 0.017). An AUC calculation using only the two‐ and five‐h measurements was strongly correlated with the AUC using all four time measurements ( R 2 = 0.846; p < 0.001). A simple weight‐based dosing approach gives a higher probability for therapeutic AUC s compared to the manufacturer‐recommended dosing in pediatric transplant patients aged six months through three yr with normal renal function. An AUC calculated using two sample times might allow for fewer blood draws in the future.