title: Adverse interactions between antifungal azoles and vincristine: review and analysis of cases.
abstract: Triazole and imidazole antifungal agents inhibit metabolism of vincristine, leading to excess vinca alkaloid exposure and severe neurotoxicity. Recent reports of debilitating interactions between vincristine and itraconazole, as well as posaconazole, voriconazole and ketoconazole underscore the need to improve medical awareness of this adverse combination. We, therefore, undertook a comprehensive analysis of reports of adverse drug interactions (ADIs) with the combination of vincristine and azole antifungal agents, established a new classification, and provided a detailed summary of these toxicities. In patients who had sufficient data for analysis, 47 individuals were identified who had an ADI with the combination of vincristine and antifungal azoles. Median age was 8 years (1.3-68 years) with 33(70%) having a diagnosis of acute lymphoblastic leukaemia. Median time to ADI with vincristine was 9.5 days with itraconazole, 13.5 days posaconazole and 30 days voriconazole. The median number of vincristine doses preceding the ADI was 2 doses with itraconazole, 3 doses posaconazole and 2 doses voriconazole. The most common severe ADIs included gastrointestinal toxicity, peripheral neuropathy, hyponatremia/SIADH, autonomic neuropathy and seizures. Recovery from these ADIs occurred in 80.6% of patients. We recommend using alternative antifungal agents if possible in patients receiving vincristine to avoid this serious and potentially life-threatening drug interaction.
authors: NIH Clinical Center Pharmacy Department, Bethesda, MD, USA.
authors: Brad
authors: B
authors: Moriyama
authors: Stacey A
authors: SA
authors: Henning
authors: Janice
authors: J
authors: Leung
authors: Oluwaseun
authors: O
authors: Falade-Nwulia
authors: Paul
authors: P
authors: Jarosinski
authors: Scott R
authors: SR
authors: Penzak
authors: Thomas J
authors: TJ
authors: Walsh
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects* / Q000627:therapeutic use; D001393:Azoles / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014750:Vincristine / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D000972:Antineoplastic Agents, Phytogenic; D001393:Azoles; D014750:Vincristine