Drug-drug interactions of antifungal agents and implications for patient care.
Drug interactions in the gastrointestinal tract, liver and kidneys result from alterations in pH, ionic complexation, and interference with membrane transport proteins and enzymatic processes involved in intestinal absorption, enteric and hepatic metabolism, renal filtration and excretion. Azole antifungals can be involved in drug interactions at all the sites, by one or more of the above mechanisms. Consequently, azoles interact with a vast array of compounds. Drug-drug interactions associated with amphotericin B formulations are predictable and result from the renal toxicity and electrolyte disturbances associated with these compounds. The echinocandins are unknown cytochrome P450 substrates and to date are relatively devoid of significant drug-drug interactions. This article reviews drug interactions involving antifungal agents that affect other agents and implications for patient care are highlighted.
Gubbins
Paul O
PO
Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. gubbinspaulo@uams.edu
Amsden
Jarrett R
JR
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism; D000141:Acidosis, Renal Tubular / Q000209:etiology; D000666:Amphotericin B / Q000494:pharmacology*; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001711:Biotransformation; D000077336:Caspofungin; D002986:Clinical Trials as Topic; D065607:Cytochrome P-450 Enzyme Inhibitors; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D054714:Echinocandins; D004791:Enzyme Inhibitors / Q000494:pharmacology; D015725:Fluconazole / Q000494:pharmacology*; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology*; D055666:Lipopeptides; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D009181:Mycoses / Q000188:drug therapy; D005791:Patient Care; D010456:Peptides, Cyclic / Q000494:pharmacology
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000935:Antifungal Agents; D065607:Cytochrome P-450 Enzyme Inhibitors; D054714:Echinocandins; D004791:Enzyme Inhibitors; D055666:Lipopeptides; D010456:Peptides, Cyclic; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D003577:Cytochrome P-450 Enzyme System; D000077336:Caspofungin