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Adverse drug interactions as a high-risk factor for lethal post-transplant complications in Chinese population.
- Source :
-
Clinical transplantation [Clin Transplant] 2013 Mar-Apr; Vol. 27 (2), pp. 255-60. Date of Electronic Publication: 2013 Jan 07. - Publication Year :
- 2013
-
Abstract
- Metabolism of triazole antifungal agents is highly competitive to conventional post-transplant immunosuppressants like cyclosporine A (CsA) via the cytochrome P450-dependent pathway. We present the first report on lethal complications that may arise due to this type of drug interaction. A retrospective survey identified 10 of 104 cases (9.62%) that suffered life-threatening complications associated with the interaction between CsA and itraconazole or voriconazole following allogeneic hematopoietic stem cell transplantation (allo-HSCT) at our center. According to the close drug monitoring, all 10 patients experienced supratherapeutic levels of CsA even with a preemptive CsA dosage reduction and prompt dose adjustment. Six patients developed grade I to III acute graft-versus-host disease (aGVHD) and eventually died from either idiopathic pneumonia syndrome or diffuse alveolar hemorrhage; another four patients died from CSA-associated neurological complications. Impaired hepatic and renal function was noted in only one of these 10 cases. The high frequency as well as the unpredictability of severe complications lead us to suggest that triazole should always be replaced by another antifungal medication (e.g., amphotericin B or Echincandins) while patients receive CsA after HSCT, especially in the Chinese population.<br /> (© 2013 John Wiley & Sons A/S.)
- Subjects :
- Adolescent
Adult
Antifungal Agents therapeutic use
Child
China
Cyclosporine therapeutic use
Drug Administration Schedule
Drug Interactions
Drug Therapy, Combination
Female
Graft Rejection prevention & control
Graft vs Host Disease chemically induced
Graft vs Host Disease mortality
Graft vs Host Disease prevention & control
Humans
Immunosuppressive Agents therapeutic use
Itraconazole therapeutic use
Male
Middle Aged
Mycoses etiology
Mycoses prevention & control
Postoperative Complications mortality
Postoperative Complications prevention & control
Pyrimidines therapeutic use
Retrospective Studies
Risk Factors
Triazoles therapeutic use
Voriconazole
Young Adult
Antifungal Agents adverse effects
Cyclosporine adverse effects
Hematopoietic Stem Cell Transplantation
Immunosuppressive Agents adverse effects
Itraconazole adverse effects
Postoperative Complications chemically induced
Pyrimidines adverse effects
Triazoles adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1399-0012
- Volume :
- 27
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Clinical transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 23294039
- Full Text :
- https://doi.org/10.1111/ctr.12070