title: Azole antimycotics and drug interactions in the perioperative period.
abstract: OBJECTIVE
  A beneficial effect of antifungal prophylaxis on the prevention of invasive fungal infections has increased the use of azole antimycotics in intensive care and during the perioperative period. At the same time more severe illnesses are treated and multiple drug therapies are employed. Thus, the potential for severe drug-drug interactions has increased. Previous studies have shown that azole antimycotics increase the risk of many clinically significant drug interactions with potentially hazardous consequences.
  
  
  RESULTS
  A recent pharmacoepidemiological study has found a more than five-fold incidence ratio in the adjusted rate of sudden death from cardiac diseases among those patients who were given simultaneously inhibitors of cytochrome P450 (CYP) enzymes and their substrates. Although new triazole antifungals are well tolerated, they still cause significant inhibition of CYP enzymes.
  
  
  CONCLUSIONS
  This review focuses on azole antimycotics and anesthetic drugs being used during the perioperative period and discusses the possible clinically significant drug-drug interactions. Azole antimycotics are amongst the strongest inhibitors of CYP-mediated drug metabolism. Anesthesiologists must be aware of the interaction potential of azole antimycotics to be able to adjust their perioperative strategies according to the patient's condition and concomitant medication.
authors.forename: Teijo I
authors.initials: TI
authors.lastname: Saari
authors.forename: Klaus T
authors.initials: KT
authors.lastname: Olkkola
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001393:Azoles / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D065607:Cytochrome P-450 Enzyme Inhibitors; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000009:adverse effects; D006801:Humans; D009181:Mycoses / Q000517:prevention & control; D019990:Perioperative Care
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D065607:Cytochrome P-450 Enzyme Inhibitors; D004791:Enzyme Inhibitors