title: Effects of Miconazole Oral Gel on Blood Concentrations of Tacrolimus and Cyclosporine: A Retrospective Observational Study.
abstract: Although azole antifungal agents have been shown to affect the pharmacokinetics of calcineurin inhibitors such as tacrolimus (TAC) and cyclosporine (CyA) by inhibiting drug metabolism, there are few clinical reports on drug interactions between miconazole (MCZ) oral gel and calcineurin inhibitors. In this study, the effects of MCZ oral gel on the blood concentrations of TAC and CyA were investigated.
  
  
  
  In this retrospective study, 18 patients concomitantly administered MCZ oral gel and TAC (9 for dermatomyositis, 3 for myasthenia gravis, 2 for systemic lupus erythematosus, 2 for rheumatoid arthritis, 1 for polymyositis, 1 for prevention of graft-versus-host disease after bone marrow transplantation), and 15 patients concomitantly administered MCZ oral gel and CyA (11 for interstitial pneumonia, 2 for pemphigus, 1 for eosinophilic granulomatosis with polyangiitis, 1 for systemic lupus erythematosus) were evaluated. The dose-adjusted blood concentrations of TAC or CyA were compared before and after the initiation of MCZ oral gel.
  
  
  
  The trough blood concentration/dose (C/D) ratios of TAC and CyA increased significantly with the administration of MCZ oral gel. The median C/D ratios of TAC and CyA increased by 108% (range: -44% to 216%) and 44% (range: -34% to 195%), respectively.
  
  
  
  These results suggest that MCZ oral gel affects the pharmacokinetics of TAC and CyA. Detailed monitoring of the blood concentrations of these drugs, followed by dose adjustments, is needed for each patient because of the difficulties associated with accurately predicting the degree of the effects of MCZ oral gel.
authors: *Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University (TMDU); Departments of †Rheumatology and ‡Pharmacokinetics and Pharmacodynamics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
authors: Yasuyoshi
authors: Y
authors: Ishiwata
authors: Masashi
authors: M
authors: Nagata
authors: Takafumi
authors: T
authors: Arai
authors: Misato
authors: M
authors: Makiishi
authors: Maho
authors: M
authors: Yoshikawa
authors: Hiromitsu
authors: H
authors: Takahashi
authors: Hitoshi
authors: H
authors: Kohsaka
authors: Masato
authors: M
authors: Yasuhara
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D065095:Calcineurin Inhibitors / Q000097:blood* / Q000493:pharmacokinetics; D016572:Cyclosporine / Q000097:blood* / Q000493:pharmacokinetics; D004347:Drug Interactions; D005260:Female; D005782:Gels / Q000008:administration & dosage*; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood*; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008825:Miconazole / Q000008:administration & dosage*; D008875:Middle Aged; D012189:Retrospective Studies; D016559:Tacrolimus / Q000097:blood* / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065095:Calcineurin Inhibitors; D005782:Gels; D007166:Immunosuppressive Agents; D008825:Miconazole; D016572:Cyclosporine; D016559:Tacrolimus