TY - JOUR
T1 - Drug-interactions of azole antifungals with selected immunosuppressants in transplant patients
T2 - strategies for optimal management in clinical practice
AU - Lempers, Vincent J.C.
AU - Martial, Lisa C.
AU - Schreuder, Michiel F.
AU - Blijlevens, Nicole M.
AU - Burger, David M.
AU - Aarnoutse, Rob E.
AU - Brüggemann, Roger J.M.
N1 - Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/7/27
Y1 - 2015/7/27
N2 - The management of drug-drug interactions (DDIs) between azole antifungals (fluconazole, itraconazole, posaconazole and voriconazole) and immunosuppressants (cyclosporine, tacrolimus, everolimus and sirolimus) in transplant patients remains challenging, as the impact of altered immunosuppressant concentrations puts the patient at high risk for either toxicity or transplant rejection. As a result, it is a complex task for the clinician to maintain immunosuppressant concentrations within the desired therapeutic range and this requires a highly individualized patient approach. We provide important tools for adequate assessment of the drug interactions that cause this pharmacokinetic variability of immunosuppressants. A stepwise approach for the evaluation and subsequent management options, including a decision flow chart, are provided for optimal handling of these clinically relevant DDIs.
AB - The management of drug-drug interactions (DDIs) between azole antifungals (fluconazole, itraconazole, posaconazole and voriconazole) and immunosuppressants (cyclosporine, tacrolimus, everolimus and sirolimus) in transplant patients remains challenging, as the impact of altered immunosuppressant concentrations puts the patient at high risk for either toxicity or transplant rejection. As a result, it is a complex task for the clinician to maintain immunosuppressant concentrations within the desired therapeutic range and this requires a highly individualized patient approach. We provide important tools for adequate assessment of the drug interactions that cause this pharmacokinetic variability of immunosuppressants. A stepwise approach for the evaluation and subsequent management options, including a decision flow chart, are provided for optimal handling of these clinically relevant DDIs.
UR - http://www.scopus.com/inward/record.url?scp=84937917942&partnerID=8YFLogxK
U2 - 10.1016/j.coph.2015.07.002
DO - 10.1016/j.coph.2015.07.002
M3 - Review article
C2 - 26218924
AN - SCOPUS:84937917942
SN - 1471-4892
VL - 24
SP - 38
EP - 44
JO - Current Opinion in Pharmacology
JF - Current Opinion in Pharmacology
M1 - 1439
ER -