title: Itraconazole-enhanced chemotherapy toxicity in a patient with Hodgkin lymphoma.
abstract: The authors describe the clinical course of a boy with Hodgkin lymphoma who developed severe myelosuppression and neurotoxicity after the concurrent administration of vinblastine, doxorubicin, methotrexate, and prednisone chemotherapy (VAMP) and itraconazole. Several case reports have identified itraconazole-enhanced chemotherapy toxicity, especially in association with vinca alkaloid chemotherapy. This patient showed similar exacerbation of chemotherapy toxicity related to concurrent administration of itraconazole and vinblastine, doxorubicin, and methotrexate. Inpatient supportive management along with withdrawal of offending drugs resulted in the resolution of myelotoxic and neurotoxic manifestations. Hepatic cytochrome P450 enzyme inhibition and P-glycoprotein pump inhibitors are believed to interfere with the metabolism of several anticancer agents. Appropriate care should be exercised when combining cancer chemotherapy with cytochrome P450 and P-glycoprotein inhibitors, such as itraconazole.
authors.affiliation: Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, 38105, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Bashir
authors.forename: Susannah
authors.initials: S
authors.lastname: Motl
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Sue
authors.initials: S
authors.lastname: Kaste
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Krasin
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D000935:Antifungal Agents / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D004317:Doxorubicin / Q000009:adverse effects; D004347:Drug Interactions; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D017964:Itraconazole / Q000009:adverse effects*; D008727:Methotrexate / Q000009:adverse effects; D011241:Prednisone / Q000009:adverse effects; D014747:Vinblastine / Q000009:adverse effects
chemical_list: D000903:Antibiotics, Antineoplastic; D000935:Antifungal Agents; D018931:Antineoplastic Agents, Hormonal; D000972:Antineoplastic Agents, Phytogenic; D017964:Itraconazole; D014747:Vinblastine; D004317:Doxorubicin; D011241:Prednisone; D008727:Methotrexate