Bloody Minded Episode 83 - On The Wards: The NBM Transplant Patient
Mar 24, 2026
Ariana McCauley, senior cancer care haematology pharmacist specialising in medication management for haematology patients, and Andriana Colic, senior haematology/BMT pharmacist who leads bone marrow transplant pharmacy services, walk through converting nil-by-mouth transplant drugs to IV. They cover immunosuppressant IV conversions, TDM pitfalls with lines, antifungal/antiviral IV choices, CMV and PJP IV strategies, antiepileptic swaps and practical ward tips.
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Bring Pharmacists Into Hematology Decisions Early
- Hematology pharmacists are essential clinical partners and should be consulted early and often for medication decisions.
- Andriana Colic and Ariana McCauley encourage clinicians to ask pharmacists and embrace their involvement in TDM and complex drug management.
Echinocandin Dosing For Prophylaxis And Treatment
- For prophylactic echinocandin use micafungin 100 mg daily; increase to 150 mg when targeting infection.
- Use anidulafungin with a 200 mg day one load then 100 mg daily, preferred if significant LFT derangement.
Convert Valacyclovir To IV Acyclovir With Renal Check
- Convert oral valacyclovir prophylaxis to IV acyclovir 5 mg/kg every 8 hours (prophylactic equivalent) with renal dosing checks.
- For treatment, use IV acyclovir 10 mg/kg every 8 hours and adjust for renal impairment.