title: [Severe neurotoxicological reaction by combined treatment with vincristine and fluconazole].
abstract: We describe the case of a woman, aged 41 years, who received a combination chemotherapy including vincristine, doxorubicine, ifosfamide and etoposide due to Ewings sarcoma. She was treated prophylactic with fluconazole to prevent oral candidosis. Unexpectedly, she developed severe neurotoxic side effects. Treatment with multiple substrates of cytochrome P450 3A4 combined with inhibition of the enzyme by fluconazole impairs metabolism and thereby increase plasma concentrations of vincristine, which is considered to be the main reason for the neurotoxic side effects.
authors.affiliation: Klinisk Farmakologisk Afdeling, Aarhus Universitetshospital, Wilhelm Meyers Allé 4, 8000 Aarhus C, Denmark. mhs@farm.au.dk
authors.forename: Maja
authors.initials: M
authors.lastname: Hellfritzsch
authors.forename: Pernille
authors.initials: P
authors.lastname: Lassen
authors.forename: Lars Peter
authors.initials: LP
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D010292:Paresthesia / Q000139:chemically induced; D012512:Sarcoma, Ewing / Q000188:drug therapy; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine; D015725:Fluconazole