MHRA advises considering delayed echinocandin administration during CRRT

What Changed

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued device safety information DSI/2026/014 on the potential for caspofungin to bind to polyacrylonitrile (PAN)-based membranes used in continuous renal replacement therapy (CRRT). This adsorption may reduce antifungal effectiveness, with potentially life-threatening consequences for critically ill patients.

Where possible and clinically appropriate, the MHRA recommends administering echinocandins such as caspofungin at least six hours after starting PAN-based filter use or changing the filter circuit. Adsorption is considered greatest when a new membrane or circuit starts and decreases as the membrane becomes saturated.

Who Is Affected

The advice concerns healthcare professionals caring for patients receiving CRRT alongside antifungal treatment. Staff involved in CRRT setup and delivery, and those prescribing, dispensing or administering caspofungin, should be made aware of the recommendation.

CRRT manages severe acute kidney injury and fluid overload and is most often used in intensive care for critically ill, haemodynamically unstable patients. Patients with concerns about the advice are directed to their healthcare professional.

Regulatory and Technical Implications

The source describes a different recommendation from the European Pharmacovigilance Risk Assessment Committee (PRAC): avoiding PAN-based membranes in patients receiving antifungals by changing membranes or selecting an alternative antifungal. After reviewing additional evidence, clinical input and UK equipment availability, the MHRA considered that approach infeasible in the UK clinical setting.

CRRT should proceed as clinically indicated and should not be delayed or paused solely to facilitate drug administration unless the responsible clinician considers this necessary. Comparative studies with other membrane types have not been conducted, and adsorption cannot conclusively be excluded for other membranes or drugs with similar properties.

Manufacturer Actions

The source specifies no manufacturer-directed action or deadline and explicitly states that there is no advice for distributors. Its operational recommendations focus on healthcare professionals and providers.

Providers are advised to review and update local protocols and standard operating procedures to address adsorption and medication timing. Clinicians should consider filter binding when treatment responses are inadequate and seek specialist pharmacy, infectious disease, medical microbiology or mycology advice where loss of efficacy is suspected.

Confirmed Dates

The source lists 13 October 2026 as both the publication and issue date. It specifies no separate compliance deadline. The interval of at least six hours is a clinically conditional medication-timing recommendation, not a regulatory deadline.

Official Source

MHRA device safety information DSI/2026/014, published on GOV.UK, concerning CRRT and concurrent echinocandin administration. The communication also states that a direct healthcare professional communication (DHPC) has been issued to convey its key safety messages.