title: Drug-interactions of azole antifungals with selected immunosuppressants in transplant patients: strategies for optimal management in clinical practice.
abstract: The management of drug-drug interactions (DDIs) between azole antifungals (fluconazole, itraconazole, posaconazole and voriconazole) and immunosuppressants (cyclosporine, tacrolimus, everolimus and sirolimus) in transplant patients remains challenging, as the impact of altered immunosuppressant concentrations puts the patient at high risk for either toxicity or transplant rejection. As a result, it is a complex task for the clinician to maintain immunosuppressant concentrations within the desired therapeutic range and this requires a highly individualized patient approach. We provide important tools for adequate assessment of the drug interactions that cause this pharmacokinetic variability of immunosuppressants. A stepwise approach for the evaluation and subsequent management options, including a decision flow chart, are provided for optimal handling of these clinically relevant DDIs.
authors.affiliation: Radboud university medical center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Vincent J C
authors.initials: VJ
authors.lastname: Lempers
authors.affiliation: Radboud university medical center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Martial
authors.affiliation: Radboud university medical center, Amalia Children's Hospital, Department of Pediatric Nephrology, Nijmegen, The Netherlands.
authors.forename: Michiel F
authors.initials: MF
authors.lastname: Schreuder
authors.affiliation: Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Radboud university medical center, Department of Hematology, Nijmegen, The Netherlands.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Blijlevens
authors.affiliation: Radboud university medical center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
authors.affiliation: Radboud university medical center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Rob E
authors.initials: RE
authors.lastname: Aarnoutse
authors.affiliation: Radboud university medical center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands. Electronic address: roger.bruggemann@radboudumc.nl.
authors.forename: Roger J M
authors.initials: RJ
authors.lastname: Brüggemann
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001393:Azoles / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016377:Organ Transplantation
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D007166:Immunosuppressive Agents