Plasmapheresis may remove important therapeutic drugs which must be replaced.
Drug removal during plasmapheresis may be an issue for:
(1) a drug that has high protein binding
(2) a drug whose distribution is limited to the intravascular space (typically indicated by a small volume of distribution)
(3) if a large volume of plasma is processed AND none of the material is returned
(4) if the drug is critical for the patient
Considerations in drug therapy:
(1) The plasma level of an essential drug should be monitored.
(2) If the drug is highly protein bound, then free drug levels should be monitored (protein levels may vary from day to day, affecting total plasma levels).
(3) A loading or bolus dose may need to be given after each pheresis procedure.
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