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Concomitant Treatment with Voriconazole and Flucloxacillin: A Combination to Avoid
- Source :
- Antibiotics, Volume 10, Issue 9, Antibiotics, Vol 10, Iss 1112, p 1112 (2021), Antibiotics, 10, Antibiotics, 10, 9
- Publication Year :
- 2021
-
Abstract
- Background: Voriconazole is an antifungal drug used as one of the first-line treatments for invasive aspergillosis. This drug is extensively metabolized, predominantly via cytochrome P450 enzymes. An interaction between flucloxacillin and voriconazole, leading to subtherapeutic voriconazole concentrations, has previously been reported. We aimed to demonstrate that flucloxacillin independently influences voriconazole exposure. Methods: Patients from three Belgian hospitals, treated with a combination of voriconazole and flucloxacillin, were included in this retrospective study. Voriconazole concentrations were collected both in a timeframe with and without flucloxacillin co-treatment. Multivariate analyses were performed to study the independent effect of flucloxacillin treatment on voriconazole exposure and the possible influence of the flucloxacillin dose. Results: Thirty-three patients were included in this study and 145 trough concentrations (51 with, and 94 without concomitant flucloxacillin treatment) were analyzed. The median (IQR) voriconazole trough concentration sampled during flucloxacillin co-treatment was 0.5 (0–1.8) mg/L, whereas samples without flucloxacillin co-treatment had a median (IQR) voriconazole trough concentration of 3.5 (1.7–5.1) mg/L (p = 0.002), while receiving similar voriconazole doses. Subtherapeutic concentrations (&lt<br />1 mg/L) were observed in 69% and 7% of the samples with flucloxacillin co-treatment versus samples without flucloxacillin co-treatment, respectively. Conclusion: This study shows that flucloxacillin co-treatment independently decreases voriconazole exposure. Caution is needed when these two drugs are administered simultaneously.
- Subjects :
- Microbiology (medical)
Drug
medicine.medical_specialty
media_common.quotation_subject
Antifungal drug
SOCIETY
underexposure
RM1-950
METABOLISM
Aspergillosis
GUIDELINES
Biochemistry
Microbiology
Gastroenterology
Article
Internal medicine
polycyclic compounds
voriconazole
Medicine
Pharmacology (medical)
Trough Concentration
Pharmacology & Pharmacy
General Pharmacology, Toxicology and Pharmaceutics
drug–drug interaction
CYP450 enzymes
media_common
Voriconazole
flucloxacillin
Science & Technology
business.industry
Pharmacology. Therapy
INDUCTION
Retrospective cohort study
medicine.disease
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Infectious Diseases
Concomitant
Human medicine
Flucloxacillin
Therapeutics. Pharmacology
business
Life Sciences & Biomedicine
drug-drug interaction
medicine.drug
Subjects
Details
- ISSN :
- 20796382
- Database :
- OpenAIRE
- Journal :
- Antibiotics, Volume 10, Issue 9, Antibiotics, Vol 10, Iss 1112, p 1112 (2021), Antibiotics, 10, Antibiotics, 10, 9
- Accession number :
- edsair.doi.dedup.....b6d18d4af8890360514eea548cf8a20b