title: Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy, 2014.
abstract: Antifungal agents may be associated with significant toxicity or drug interactions leading to sub-therapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy. These risks may be minimised by clinical assessment, laboratory monitoring, avoidance of particular drug combinations and dose modification. Specific measures, such as the optimal timing of oral drug administration in relation to meals, use of pre-hydration and electrolyte supplementation may also be required. Therapeutic drug monitoring (TDM) of antifungal agents is warranted, especially where non-compliance, non-linear pharmacokinetics, inadequate absorption, a narrow therapeutic window, suspected drug interaction or unexpected toxicity are encountered. Recommended indications for voriconazole and posaconazole TDM in the clinical management of haematology patients are provided. With emerging knowledge regarding the impact of pharmacogenomics upon metabolism of azole agents (particularly voriconazole), potential applications of pharmacogenomic evaluation to clinical practice are proposed.
authors.affiliation: Pharmacy Department, The Royal Melbourne Hospital, Melbourne Health, Parkville, Victoria.
authors.forename: M M
authors.initials: MM
authors.lastname: Chau
authors.forename: D C M
authors.initials: DC
authors.lastname: Kong
authors.forename: S J
authors.initials: SJ
authors.lastname: van Hal
authors.forename: K
authors.initials: K
authors.lastname: Urbancic
authors.forename: J A
authors.initials: JA
authors.lastname: Trubiano
authors.forename: M
authors.initials: M
authors.lastname: Cassumbhoy
authors.forename: J
authors.initials: J
authors.lastname: Wilkes
authors.forename: C M
authors.initials: CM
authors.lastname: Cooper
authors.forename: J A
authors.initials: JA
authors.lastname: Roberts
authors.forename: D J E
authors.initials: DJ
authors.lastname: Marriott
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D032921:Consensus; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems; D054796:Drug Dosage Calculations; D004347:Drug Interactions; D016903:Drug Monitoring; D019337:Hematologic Neoplasms / Q000150:complications / Q000276:immunology* / Q000628:therapy; D006801:Humans; D008969:Molecular Sequence Data; D009181:Mycoses / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D009894:Opportunistic Infections / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D015532:Rehydration Solutions; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects; D065819:Voriconazole / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D015532:Rehydration Solutions; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole
keywords: antifungal therapy; drug interaction; pharmacogenomics; therapeutic drug monitoring; toxicity