Evaluación de interacción medicamentosa de voriconazol-ciclosporina en pacientes pediátricos que reciben trasplante de precursores hematopoyéticos (2013-2014)

Valenzuela, Rodrigo; Torres, Juan Pablo; Salas, Carolina; Gajardo, Iván; Palma, Julia; Catalán, Paula; Santolaya, Marı́a Elena; Morales, Jorge

doi:10.4067/s0716-10182017000100002

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Te CsA dose for most patients was adjusted according to the monitored results, which were within the therapeutic window (150-250) ng/mL. It seems cautious not to automatically reduce the dose in advance [38][39][40][41]. Terefore, it is preferable to adjust the CsA dose through therapeutic drug monitoring.…”

Section: Discussionmentioning

confidence: 99%

Effects of Triazole Antifungal Agents on the Plasma Concentration and Dosage of Cyclosporin in Patients with Aplastic Anaemia

Tian,

Song,

Qiao

et al. 2024

Journal of Clinical Pharmacy and Therapeutics

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Objectives. This study aimed to investigate the effects of different triazole antifungal agents on the blood concentration and dosage of cyclosporine (CsA) in patients with aplastic anaemia (AA). Methods. This retrospective study enrolled AA patients who received CsA and triazole antifungal agents simultaneously between January 2018 and December 2022. The ratio of CsA blood concentration (ng/mL) to dosage (mg/day) (C/D) co-administration with and without azoles was compared. The effects of different triazole antifungal agents on blood concentrations and dosages of CsA were analysed. Results. The mean C/D ratio of CsA increased 1.97 times when co-administered with posaconazole (POS), while the mean C/D ratio of CsA increased 1.76 times when co-administered with fluconazole (FCZ). Compared with CsA monotherapy, there was a significant difference in CsA concentrations among patients with azoles (P<0.05). The mean dose of CsA decreased was 0.26 (−0.25—1.05) mg/kg/day and 0.18 (−0.50—0.69) mg/kg/day when co-administered with POS and FCZ, respectively. There is a wide interindividual variability in the magnitude of drug interaction between azoles and CsA. Conclusions. Although azoles increased CsA concentration, a wide individual variability was found in the patients with CsA C/D ratio. Therefore, the CsA dose should be adjusted by closely monitoring the blood levels of CsA co-administered with triazole antifungal agents. In addition, we observed that POS had a greater effect on the blood concentration of CsA than FCZ. When adjusting the dose of CsA in clinical practice, the blood concentration of CsA and the type of co-administered triazole antifungal agents should be considered.

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Section: Discussionmentioning

confidence: 99%

Effects of Triazole Antifungal Agents on the Plasma Concentration and Dosage of Cyclosporin in Patients with Aplastic Anaemia

Tian,

Song,

Qiao

et al. 2024

Journal of Clinical Pharmacy and Therapeutics

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“…Dose reduction of immunosuppressants is necessary to sustain the therapeutic levels of the drug and reduce adverse events associated with increased concentrations. [12], and Masoumi et al claimed that the CsA C/D ratio increased signi cantly by a factor of 1.4 [21], when CsA was concurrently used with voriconazole in HSCT patients. A similar effect was observed for POS in our study, with an approximately 1.5-fold increase in the C/D ratio, which supports the ndings of Groll et al [16,22].…”

Section: Discussionmentioning

confidence: 99%

“…Drug-drug interactions between azoles and immunosuppressants have received increasing attention in the clinical treatment of transplant recipients. In previous studies, concomitant administration of azoles (e.g., ketoconazole, itraconazole, or voriconazole) with CsA in transplant recipients increased exposure to CsA by 70-438%, and the dosage of CsA was reduced by 48-78% [11][12][13][14]. Similar to other azole antifungal agents, POS substantially increases the plasma concentrations of immunosuppressants.…”

Section: Introductionmentioning

confidence: 93%

Effect of posaconazole on the concentration of intravenous and oral cyclosporine in patients undergoing hematopoietic stem cell transplantation

Zhu

Huang

Cai

et al. 2022

Eur J Clin Pharmacol

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This study aimed to investigate the interactions between posaconazole (POS) and intravenously/orally administered Cyclosporine A (CsA) in allogeneic hematopoietic stem cell transplant (HSCT) recipients. MethodsWe included 118 allogeneic HSCT patients who received CsA and POS simultaneously between January 2017 and June 2020 this study. The ratio of CsA blood concentration (ng/mL) to dosage (mg/day) (C/D) before and after POS initiation was compared. ResultsAfter the initiation of POS, the level of CsA increased 1 to 2 times in 66% (78/118) of patients compared to those without POS. However, the CsA C/D ratio increased by more than threefold in 6% (7/118) of patients after POS initiation, with an increase of more than fourfold in two patients. The median C/D ratio of CsA increased from 0.89 to 1.23 (P < 0.001) and 0.78 to 1.22 (P < 0.001) after POS initiation when CsA was administered intravenously and orally, respectively. In patients who received POS at the time of transition from intravenous to oral CsA, the value increased from 1.01 to 1.38 (P = 0.001). The route of administration had no signi cant effect on the change in the CsA C/D ratio (P = 0.615). Additionally, we observed the time required for the C/D ratio to reach a plateau after POS initiation was similar on days 13, 8, and 15 under various scenarios. ConclusionPOS treatment increased blood CsA levels. A large variability was found in the fold-change in the CsA C/D ratio. Therefore, CsA doses should be adjusted by closely monitoring the blood levels of CsA after POS initiation.

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“…Dr. Suarez-Kurtz also coordinates the Brazilian Pharmacogenetics Network, an initiative of Brazilian researchers, which aims to promote and coordinate integrated research projects in pharmacogenetics/pharmacogenomics in the Brazilian population (REFARGEN). Still, interesting studies on TDM in children were performed in Argentina, a population evaluation of pharmacokinetics of amikacin in patients with cystic fibrosis [7], and in Chile, an evaluation of drug interaction of voriconazole and cyclosporine in hematopoietic stem cell transplantation [8].…”

Section: State Of Affairs In South Americamentioning

confidence: 99%

Therapeutic drug monitoring in developing nations: assessing the current state of affairs in South America

Antunes

Linden

Schaiquevich

2021

Expert Opinion on Drug Metabolism & Toxicology

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Evaluación de interacción medicamentosa de voriconazol-ciclosporina en pacientes pediátricos que reciben trasplante de precursores hematopoyéticos (2013-2014)

Cited by 5 publications

References 7 publications

Effects of Triazole Antifungal Agents on the Plasma Concentration and Dosage of Cyclosporin in Patients with Aplastic Anaemia

Effects of Triazole Antifungal Agents on the Plasma Concentration and Dosage of Cyclosporin in Patients with Aplastic Anaemia

Effect of posaconazole on the concentration of intravenous and oral cyclosporine in patients undergoing hematopoietic stem cell transplantation

Therapeutic drug monitoring in developing nations: assessing the current state of affairs in South America

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