title: [Two cases of pulmonary aspergilosis, which deteriorated with generic itraconazole].
abstract: We experienced two cases of pulmonary aspergillosis, which deteriorated during treatment with generic itraconazole (ITCZ) because of low plasma concentration. One case was chronic pulmonary aspergillosis and the other was allergic bronchopulmonary aspergillosis (ABPA). Treatment of both cases was started with a brand-name-ITCZ, and changed to a generic ITCZ. Deterioration of pulmonary aspergillosis occurred after 8 months and 9 months from change to generic ITCZ respectively. In the first case, the ITCZ-plasma concentration was 46.9 ng/mL and of OH-ITCZ 96.5 ng/mL with generic ITCZ at the dose of 300 mg/day, but increased to 1,559.7 ng/mL and to 2,485.0 ng/mL with the brand-name-ITCZ 300 mg/day, respectively. In the second case, the ITCZ-plasma concentration was 27.2 ng/mL and of OH-ITCZ 20.1 ng/mL with 150 mg/day for generic ITCZ, but reached 857.3 ng/mL and to 1,144.2 ng/ml with the brand-name-ITCZ 300 mg/day, respectively. After treatment failure, the first case was changed to voriconazole, then brand-name-ITCZ 300 mg/day, and the second case to the brand-name-ITCZ 300 mg/day, with successful clinical course. Plasma concentrations of ITCZ can differ significantly depending on the patient or type of ITCZ. The ITCZ-plasma concentration should be controlled after changing from a brand-name-ITCZ to a generic ITCZ.
authors.forename: Wakana
authors.initials: W
authors.lastname: Saito
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shishikura
authors.forename: Katsushi
authors.initials: K
authors.lastname: Nishimaki
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Kan
authors.initials: K
authors.lastname: Sasamori
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miki
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D016568:Drugs, Generic / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D016568:Drugs, Generic; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D065819:Voriconazole