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Postpartum Pharmacokinetics of Peramivir in the Treatment of 2009 H1N1 Influenza

Clay, Patrick G. PharmD; Adiga, Raghavendra B. MD; Taylor, Tracey A. H. PhD; Alsup, Rachael PharmD; Gerk, Phillip M. PharmD, PhD; McRae, MaryPeace PharmD, PhD

doi: 10.1097/AOG.0b013e31821b1b3e
Case Reports
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BACKGROUND: 2009 H1N1 influenza A disproportionately affected pregnant and postpartum women compared with the general population, with higher rates of hospitalization and severe illness. We present a case of the use and pharmacokinetics of intravenous peramivir in the treatment of a patient with severe influenza.

CASE: A 28-year-old woman at 37 weeks of gestation presented to the hospital with severe respiratory symptoms. 2009 H1N1 influenza reverse transcriptase polymerase chain reaction returned positive results and intravenous peramivir was started. She showed rapid improvement and was discharged 29 days after admission.

CONCLUSION: The pharmacokinetic parameters in this patient were unexpected because the clearances occurred more quickly than in phase I trials. These differences highlight the need for additional pharmacokinetic reporting of peramivir in pregnant and postpartum women.

The use of peramivir for the treatment of severe 2009 H1N1 influenza in a newly postpartum woman results in pharmacokinetic differences when compared with results of clinical trials.

From the Kansas City University of Medicine and Biosciences, Kansas City, Missouri; Liberty Hospital, Liberty, Missouri; St. Louis College of Pharmacy, Affton, Missouri; and Virginia Commonwealth University, Richmond, Virginia.

Partial salary support for Dr. Gerk was funded by National Institutes of Health MD 002256.

The authors thank BioCryst for providing the medication within 24 hours of request as well as the details regarding their LC-MS/MS drug assay methodology.

Corresponding author: Tracey A. H. Taylor, Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106; e-mail: ttaylor@kcumb.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists