Pharmacokinetic interaction between voriconazole and ciclosporin A following allogeneic bone marrow transplantation.
Voriconazole is a novel antifungal triazole that undergoes extensive oxidative metabolization involving several CYP450 isoenzymes. We report the case of a 14-year-old patient who received voriconazole concomitant with ciclosporin A as secondary antifungal prophylaxis after bone marrow transplantation. Temporary discontinuation of voriconazole due to worsening liver function tests (LFTs) resulted in a sudden drop of ciclosporin A trough levels in blood. Ciclosporin A trough levels returned to baseline following normalization of LFTs and re-institution of voriconazole. This report emphasizes the need for careful monitoring and dose adjustments of ciclosporin A in patients receiving concomitant voriconazole, and in whom voriconazole is discontinued in order to prevent subtherapeutic ciclosporin A levels with the potential consequence of graft-versus-host disease.
Groll
Andreas H
AH
Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital, Domagkstrasse 9a, 48129 Münster, Germany. grollan@mednet.uni-muenster.de
Kolve
Hedwig
H
Ehlert
Karoline
K
Paulussen
Michael
M
Vormoor
Josef
J
D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D016572:Cyclosporine / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D009181:Mycoses / Q000517:prevention & control*; D011743:Pyrimidines / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014230:Triazoles / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D016572:Cyclosporine; D065819:Voriconazole