Pharmacokinetic/Pharmacodynamic Analysis the Probability of Target Attainment of Posaconazole against &amp;lt;i&amp;gt;Mucorales&amp;lt;/i&amp;gt; Species in Patients with Mucormycosis

Wang, Ying; Zhao, Jinfang; Yao, Yinhui; Hu, Junhui; Hu, Jiuli; Xiao, Xu; Zhao, Yanwu

doi:10.4236/pp.2020.115007

Cited by 1 publication

(3 citation statements)

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“…Posaconazole use is recommended for the prevention of invasive fungal disease in hematopoietic stem-cell transplantation (HSCT) recipients with graft-versus-host disease, and in patients with acute myelogenous leukemia or myelodysplastic syndromes who undergo intensive chemotherapy. It is also approved for the salvage treatment of patients with invasive aspergillosis, and to treat oropharyngeal candidiasis as a first-line therapy in patients who have severe disease or are immunocompromised [81][82][83].…”

Section: Triazole Compoundsmentioning

confidence: 99%

“…PharmaGKB presents 3 prescribing info, 6 drug label annotations and 4 clinical annotations. The CPIC published a guideline for voriconazole and the European Medicines Agency (EMA) also published clinical annotations for voriconazole and posaconazole [20,81,83,106].…”

Section: Azolesmentioning

confidence: 99%

“…Posaconazole is not metabolized to a significant extent via the CYP enzyme system; however, it is a potent inhibitor of CYP3A4, which justifies the clinical annotation of EMA. Therefore, plasma concentrations of drugs that are metabolized by CYP3A4 (tacrolimus, sirolimus, atazanavir, HMG-CoA reductase inhibitors (atorvastatin, lovastatin and simvastatin) and benzodiazepine, among others) may be increased by posaconazole [83,106].…”

Section: Azolesmentioning

confidence: 99%

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Antifungals: From Pharmacokinetics to Clinical Practice

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The use of antifungal drugs started in the 1950s with polyenes nystatin, natamycin and amphotericin B-deoxycholate (AmB). Until the present day, AmB has been considered to be a hallmark in the treatment of invasive systemic fungal infections. Nevertheless, the success and the use of AmB were associated with severe adverse effects which stimulated the development of new antifungal drugs such as azoles, pyrimidine antimetabolite, mitotic inhibitors, allylamines and echinochandins. However, all of these drugs presented one or more limitations associated with adverse reactions, administration route and more recently the development of resistance. To worsen this scenario, there has been an increase in fungal infections, especially in invasive systemic fungal infections that are particularly difficult to diagnose and treat. In 2022, the World Health Organization (WHO) published the first fungal priority pathogens list, alerting people to the increased incidence of invasive systemic fungal infections and to the associated risk of mortality/morbidity. The report also emphasized the need to rationally use existing drugs and develop new drugs. In this review, we performed an overview of the history of antifungals and their classification, mechanism of action, pharmacokinetic/pharmacodynamic (PK/PD) characteristics and clinical applications. In parallel, we also addressed the contribution of fungi biology and genetics to the development of resistance to antifungal drugs. Considering that drug effectiveness also depends on the mammalian host, we provide an overview on the roles of therapeutic drug monitoring and pharmacogenomics as means to improve the outcome, prevent/reduce antifungal toxicity and prevent the emergence of antifungal resistance. Finally, we present the new antifungals and their main characteristics.

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Section: Triazole Compoundsmentioning

confidence: 99%