Should We Take the Serum Albumin Value into Account When Adjusting the Vancomycin Dosage?
Abstract:
Monitoring the pharmacokinetics of drugs with a narrow therapeutic index is essential to optimize efficacy and minimize toxicity. Vancomycin is primarily eliminated through glomerular filtration and has approximately 55% protein bounding . As albumin is the main circulating transport protein, hypoalbuminemia can influence the pharmacokinetic and pharmacodynamic behavior of bound drugs . In our clinical practice, we observed unexpectedly elevated vancomycin trough concentrations in predominantly elderly patients with hypoalbuminemia. This prompted a review of the literature to assess its impact on vancomycin pharmacokinetics. A PubMed search conducted in August 2024 using the terms “vancomycin” and “hypoalbuminemia” yielded 37 results, of which only two met inclusion criteria. In a study of septic adults, 41% over 65 years, severe hypoalbuminemia (2.5 g/dL) was associated with a high likelihood that a loading dose was unnecessary and risked toxic trough values . A second study, including adults with 50% over 75 years, showed that vancomycin half-life was significantly prolonged in severe versus non-severe hypoalbuminemia (33.2 ± 5.4 vs 24.9 ± 1.6 hours; P = 0.049). It also reported higher nephrotoxicity in severe hypoalbuminemia (26% vs 8%; P < 0.001). These findings highlight hypoalbuminemia as a relevant factor when dosing vancomycin. Future work will focus on developing a robust research protocol to further confirm its impact. We conclude that incorporating albumin levels into pharmacokinetic monitoring may help prevent overdosing and improve patient safety.
