Substantial Impairment of Voriconazole Clearance by High-Dose Meropenem in a Patient With Renal Failure

Mahmoudi, Mazyar; Brenner, Thorsten; Hatiboglu, Gencay; Burhenne, Jürgen; Weiß, Johanna; Weigand, Markus; Haefeli, Walter E.

doi:10.1093/cid/cix443

Cited by 12 publications

(6 citation statements)

References 11 publications

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“…Twenty articles that met the inclusion criteria were reviewed and the results showed that the VRZ C min and CRP-level curves were highly consistent, suggesting that VRZ concentration was significantly correlated with the level of inflammation in the body. 44,45 The effect of inflammation on VRZ metabolism appears to be more prominent with age. 44,45 The results of two studies on children also showed that the effect of the inflammatory state on VRZ metabolism in children needs to be analysed along with age groups.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty articles that met the inclusion criteria were reviewed and the results showed that the VRZ C min and CRP‐level curves were highly consistent, suggesting that VRZ concentration was significantly correlated with the level of inflammation in the body 44,45 . The effect of inflammation on VRZ metabolism appears to be more prominent with age 44,45 …”

Section: Discussionmentioning

confidence: 99%

“…44,45 The effect of inflammation on VRZ metabolism appears to be more prominent with age. 44,45 The results of two studies on children also showed that the effect of the inflammatory state on VRZ metabolism in children needs to be analysed along with age groups. This may be related to the following factors: (1) the hepatic blood flow in children is higher than that in adults;…”

Section: Discussionmentioning

confidence: 99%

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Effects of inflammation on voriconazole levels: A systematic review

Lai

Jiang

et al. 2022

Brit J Clinical Pharma

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Aims This study aimed to review the studies evaluating the effect of the inflammatory state on voriconazole (VRZ) levels. Methods The study included randomized clinical trials, cohort studies, and case–control studies that focused on the influence of the inflammatory state on VRZ levels. Following the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines, relevant articles published until 2021 were searched in several databases, including PubMed, Embase, Web of Science and the Cochrane Library. Results Twenty studies were included in this review, of which 15 described adult populations, three described paediatric populations, and two included both adult and paediatric populations. Seventeen studies used C‐reactive protein (CRP) as an indicator of inflammation, six described a dose–response relationship for the effect of inflammation represented by CRP on VRZ concentrations, and four examined the effect of CRP on the metabolic rate of VRZ. Conclusions Our findings showed that the level of inflammation can significantly affect VRZ levels. However, the effect of inflammation on VRZ concentrations in children is controversial and must be analysed along with age. Clinicians dosing VRZ should take into account the patient's inflammatory state. The impact of inflammation on genotype‐based dosing decisions requires further study to explain the high pharmacokinetic variability of VRZ.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of inflammation on voriconazole levels: A systematic review

Lai

Jiang

et al. 2022

Brit J Clinical Pharma

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“…There is a report that high-dose meropenem inhibits CYP2C19 and CYP3A4. [14] So high-dose meropenem can potentially change the exposure of rivaroxaban metabolized by CYP3A4. But this patient was on conventional-dose meropenem; there may be no drug interaction between meropenem and rivaroxaban.…”

Section: Discussionmentioning

confidence: 99%

Poor response to rivaroxaban in nephrotic syndrome with acute deep vein thrombosis

Chen

et al. 2019

Medicine

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Rationale: Hypercoagulability can lead to thromboembolic events that are a life-threatening complication of nephrotic syndrome (NS). Conventional anticoagulants are first-line treatment in the presence of demonstrated thrombosis in NS. Direct-acting oral anticoagulants (DOACs) have provided useful alternatives for the prevention and treatment of thromboembolic events. Patient concerns: A 59-year-old male developed lower limbs deep vein thrombosis (DVT) during the early course of NS but presented poor response to oral therapeutic doses of rivaroxaban. The decision was made to switch from rivaroxaban to heparin and subsequently bridged to warfarin. The patient presented significant clinical symptom improvement. Diagnosis: NS with Lower limbs DVT. Interventions: Rivaroxaban was discontinued and switch to heparin and subsequently bridged to warfarin. Outcomes: Venography result of both lower limb vein showed the venous wall was smooth without obvious stenosis or obstruction. Edema of the patient's lower limbs gradually improved and disappeared. Lessons: The existing published data on the application of DOACs in NS are limited. DOACs have an immediate anticoagulant effect and have demonstrated safety and efficacy and required no routine monitoring, however, application of these agents in NS likely requires further investigation before widespread adoption.

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“…In 2017, Mahmoudi and co-workers reported the case of a critically ill patient which repeatedly required profound voriconazole dose reduction when high-dose meropenem was added [ 46 ]. The authors also performed in vitro assessments providing for the first time evidence that meropenem may inhibit the CYP2C19 and CYP3A4 isoforms.…”

Section: Antibiotics As Victims or Perpetrators Of Pddismentioning

confidence: 99%

The Issue of Pharmacokinetic-Driven Drug-Drug Interactions of Antibiotics: A Narrative Review

Cattaneo

Gervasoni

Corona³

2022

Antibiotics

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Patients in intensive care units (ICU) are at high risk to experience potential drug-drug interactions (pDDIs) because of the complexity of their drug regimens. Such pDDIs may be driven by pharmacokinetic or pharmacodynamic mechanisms with clinically relevant consequences in terms of treatment failure or development of drug-related adverse events. The aim of this paper is to review the pharmacokinetic-driven pDDIs involving antibiotics in ICU adult patients. A MEDLINE Pubmed search for articles published from January 2000 to June 2022 was completed matching the terms “drug-drug interactions” with “pharmacokinetics”, “antibiotics”, and “ICU” or “critically-ill patients”. Moreover, additional studies were identified from the reference list of retrieved articles. Some important pharmacokinetic pDDIs involving antibiotics as victims or perpetrators have been identified, although not specifically in the ICU settings. Remarkably, most of them relate to the older antibiotics whereas novel molecules seem to be associated with a low potential for pDDIs with the exceptions of oritavancin as potential perpetrator, and eravacicline that may be a victim of strong CYP3A inducers. Personalized therapeutic drug regimens by means of available web-based pDDI checkers, eventually combined with therapeutic drug monitoring, when available, have the potential to improve the response of ICU patients to antibiotic therapies.

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Substantial Impairment of Voriconazole Clearance by High-Dose Meropenem in a Patient With Renal Failure

Cited by 12 publications

References 11 publications

Effects of inflammation on voriconazole levels: A systematic review

Effects of inflammation on voriconazole levels: A systematic review

Poor response to rivaroxaban in nephrotic syndrome with acute deep vein thrombosis

The Issue of Pharmacokinetic-Driven Drug-Drug Interactions of Antibiotics: A Narrative Review

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