Back to Search
Start Over
Interaction of azoles with rifampin, phenytoin, and carbamazepine: in vitro and clinical observations.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 1992 Jan; Vol. 14 (1), pp. 165-74. - Publication Year :
- 1992
-
Abstract
- Twelve patients receiving therapy with an azole agent (ketoconazole, itraconazole, and/or fluconazole) for systemic mycoses experienced drug interactions with rifampin, phenytoin, and/or carbamazepine resulting in substantial decreases in azole concentrations in serum. All four patients receiving azoles and concurrent phenytoin and/or carbamazepine failed to respond to treatment or suffered a relapse of their fungal infection. Four of five patients with cryptococcosis who received itraconazole and rifampin responded despite decreases in their serum itraconazole concentrations; synergy between itraconazole and rifampin was documented by in vitro analysis of inhibition and of killing of Cryptococcus neoformans isolates from all patients receiving this combination. In contrast, two patients with coccidioidomycosis failed to respond to itraconazole/rifampin. Moreover, two patients with cryptococcosis suffered a relapse or persistence of seborrheic dermatitis while receiving itraconazole/rifampin. The latter combination showed synergy in vitro in the inhibition of the mycelial phase of Coccidioides immitis and, to a lesser extent, of the pathogenic spherule phase of this fungus; synergy in the killing of C. immitis was not noted, nor was synergy seen against Malassezia furfur, the purported etiologic agent of seborrheic dermatitis. These findings illustrate several drug interactions that may affect clinical outcome and that must be considered in the management of antifungal therapy.
- Subjects :
- Adult
Aged
Antifungal Agents pharmacokinetics
Antifungal Agents therapeutic use
Azoles pharmacokinetics
Azoles therapeutic use
Carbamazepine therapeutic use
Coccidioides drug effects
Cryptococcus neoformans drug effects
Drug Interactions
Drug Therapy, Combination
Female
Fluconazole pharmacokinetics
Fluconazole pharmacology
Fluconazole therapeutic use
Humans
Itraconazole
Ketoconazole analogs & derivatives
Ketoconazole pharmacokinetics
Ketoconazole pharmacology
Ketoconazole therapeutic use
Malassezia drug effects
Male
Middle Aged
Mycoses drug therapy
Phenytoin therapeutic use
Rifampin therapeutic use
Antifungal Agents pharmacology
Azoles pharmacology
Carbamazepine pharmacology
Phenytoin pharmacology
Rifampin pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 1058-4838
- Volume :
- 14
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 1315160
- Full Text :
- https://doi.org/10.1093/clinids/14.1.165