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The discussion explains formulation considerations, highlighting the role and accumulation risk of the solubilizer SBECD, and reviews available evidence on SBECD and voriconazole clearance under CRRT. 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Critical illness and CRRT further complicate achieving appropriate drug exposure.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What role does SBECD play in voriconazole injection, and why does it matter in renal impairment?",{"text":117,"@type":113},"SBECD is added as a solubilizing agent in the injection formulation. Because SBECD can accumulate in patients with reduced renal function, its clearance under dialysis/CRRT is an important safety and exposure consideration.",{"name":119,"@type":110,"acceptedAnswer":120},"What pharmacokinetic evidence is summarized for voriconazole under CRRT?",{"text":121,"@type":113},"The text provides tabled pharmacokinetic parameter estimates from population models and studies that include CRRT as a covariate and report clearance values under CRRT for different patient populations and sampling strategies.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},411154,1790790827,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","TYPE Opinion  \nPUBLISHED 18 December 2025 DOI 10.3389/fphar.2025.1736767  \nOPEN ACCESS  \nEDITED BY  \nCyprian Onyeji,  \nUniversity of Nigeria, Nigeria  \nREVIEWED BY  \nBilgen Basgut,  \nBaskent University, Türkiye  \n*CORRESPONDENCE  \nXia Wang,  \n [wangxia1@qdu.edu.cn](wangxia1@qdu.edu.cn)[ ](wangxia1@qdu.edu.cn)Huaiyu Zheng,  \n [15924002776@163.com](15924002776@163.com)  \nRECEIVED 31 October 2025  \nREVISED 04 December 2025  \nACCEPTED 09 December 2025  \nPUBLISHED 18 December 2025  \nCITATION  \nZhou L, Yu Z, Wang X and Zheng H (2025) Voriconazole injection use in patients receiving continuous renal replacement therapy.  \nFront. Pharmacol. 16:1736767 .  \ndoi: 10.3389/fphar.2025.1736767  \nCOPYRIGHT  \n© 2025 Zhou, Yu, Wang and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nVoriconazole injection use inpatients receiving continuous renal replacement therapy  \nLing Zhou 1, Zhenwei Yu 2, Xia Wang 3* and Huaiyu Zheng 1*  \n1Department of Pharmacy, Zhoushan Hospital, Zhoushan, China, 2Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China, 3Department of Pharmacy, The Affiliated Taian City Central Hospital of Qingdao University, Taian, China  \nKEYWORDS  \nCRRT, injection, pharmacokinetic, sulphobutylether beta-cyclodextrin, therapeutic drug monitoring, voriconazole  \nIntroduction  \nVoriconazole is a widely used anti-fungal drug with narrow therapeutic window (McCreary et al., 2023) . It has shown large inter-individual variation in pharmacokinetics. Given the special pathophysiological condition of intensive care patients, the variation in voriconazole exposure would be even larger (Hinze et al., 2024) . Thus, injection formulation could avoid absorption variation and is preferred in ICU. Continuous renal replacement therapy (CRRT) is a common organ support treatment for ICU patients, and it is challenge for dosing voriconazole for these patients. Recently, Wang et al. developed a population pharmacokinetic model ofvoriconazole injections for patients with pulmonary aspergillosis, and CRRT was a covariate of the final model (Wanget al., 2025) . Another earlier study also included CRRT as covariate for voriconazole PPK model (Wang et al., 2024) . These evidences would guide voriconazole dosing in patients receiving CRRT. However, we would like to share our opinion about voriconazole injection use in these patients.  \nFormulation and pharmacokinetic considerations of voriconazole injection application in CRRT patients  \nOwing to the low water solubility of voriconazole, sulphobutylether beta-cyclodextrin (SBECD) was added as a solubilization agent in its injection formulation. Each bottle of voriconazole injection contained approximately 3200 mg of SBECD. As SBECD could accumulate in patients with renal impairment, patients with creatinine clearance \u003C50 mL/ min were advised to receive an oral formulation. According to its insert, the clearance rates of voriconazole and SBECD during hemodialysis were 121 mL/min and 55 mL/min, respectively. These findings indicate that 4-h hemodialysis can only remove small parts of voriconazole and SBECD. Real-world evidence concerning SBECD clearance by CRRT is limited. A previous study in three intensive patients receiving intravenous voriconazole and intermittent dialysis therapy revealed that the SBECD plasma concentrations were greater than 400 mg/mL (von Mach et al., 2006) . A subsequent case series also detected SBECD accumulation in four critically ill patients with acute kidney injury under extended daily dialysis (Burkhardt et al., 2010) . The troug","cbCaipj3WqgcnMJR","https://ap.wps.com/l/cbCaipj3WqgcnMJR","pdf",563784,"English","# Introduction\n# Formulation and pharmacokinetic considerations of voriconazole injection application in CRRT patients\n## Pharmacokinetic parameter estimates under CRRT","[{\"question\":\"Why is dosing voriconazole challenging in ICU patients receiving CRRT?\",\"answer\":\"Voriconazole has a narrow therapeutic window and shows large inter-individual pharmacokinetic variability. Critical illness and CRRT further complicate achieving appropriate drug exposure.\"},{\"question\":\"What role does SBECD play in voriconazole injection, and why does it matter in renal impairment?\",\"answer\":\"SBECD is added as a solubilizing agent in the injection formulation. Because SBECD can accumulate in patients with reduced renal function, its clearance under dialysis/CRRT is an important safety and exposure consideration.\"},{\"question\":\"What pharmacokinetic evidence is summarized for voriconazole under CRRT?\",\"answer\":\"The text provides tabled pharmacokinetic parameter estimates from population models and studies that include CRRT as a covariate and report clearance values under CRRT for different patient populations and sampling strategies.\"}]","Voriconazole injection use in patients receiving continuous renal replacement therapy | PDF",1790587633]