Therapeutic drug monitoring of antifungals: pharmacokinetic and pharmacodynamic considerations.
Therapeutic drug monitoring of any pharmacologic agent should be considered when there is both significant pharmacokinetic variability and strong, clinically relevant, exposure-effect relationships. Many antifungal drugs exhibit marked variability in drug concentration as a result of inconsistent absorption, metabolism, elimination, or interaction with concomitant medications. For each of the available antifungal drugs, both preclinical and clinical trials have exhibited a relationship between serum concentrations and treatment efficacy. For a smaller subset of compounds, a similar relationship has been identified for the toxicity. The kinetic variability among patients falls outside the therapeutic window for a group of four antifungal compounds. This review summarizes the current literature on therapeutic drug monitoring for these antifungal agents.
Smith
Jeannina
J
Department of Medicine, Section of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA.
Andes
David
D
D000935:Antifungal Agents / Q000493:pharmacokinetics* / Q000494:pharmacology* / Q000627:therapeutic use; D016903:Drug Monitoring; D015725:Fluconazole / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D005437:Flucytosine / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D009181:Mycoses / Q000188:drug therapy; D011743:Pyrimidines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D014230:Triazoles / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole; D005437:Flucytosine; D065819:Voriconazole