Pharmacy Department, Research Centre for Clinical Pharmacy, University Hospitals Leuven, Leuven, Belgium.
Pharmacology. 2012;90(5-6):247-50. doi: 10.1159/000342906. Epub 2012 Sep 20.
Caspofungin is the first echinocandin approved for the treatment of invasive fungal infections (IFI). As it is also well tolerated in patients with liver cirrhosis, caspofungin is an alternative for azoles in the treatment of IFI in patients with hepatic insufficiency.
We report, for the first time, the pharmacokinetics (PK) of caspofungin in a patient with Child A cirrhosis and a transjugular intrahepatic portosystemic shunt (TIPS) and compare values to previously published results.
Caspofungin plasma levels were determined on days 14 (before TIPS reduction) and 29 (after TIPS reduction) of treatment. Troughs and peaks were 3.55 and 3.34 mg/l on day 14 and 9.28 and 9.49 mg/l on day 29, resulting in, (1) PK parameters only slightly higher than previously reported results in healthy volunteers and patients with Child A liver cirrhosis without TIPS and (2) similar exposures before versus after TIPS reduction. This limited increase in exposure is not expected to be correlated to toxicity.
Caspofungin is a safe alternative for azoles when treating patients with TIPS suffering from IFI.
卡泊芬净是首个获批用于治疗侵袭性真菌感染（IFI）的棘白菌素类药物。由于其在肝硬化患者中也具有良好的耐受性，因此在治疗肝功能不全患者的 IFI 时，卡泊芬净可作为唑类药物的替代药物。
我们首次报告了一名患有 A 级肝硬化和经颈静脉肝内门体分流术（TIPS）的患者的卡泊芬净药代动力学（PK）数据，并将这些结果与之前发表的结果进行了比较。
在治疗的第 14 天（TIPS 降低前）和第 29 天（TIPS 降低后）测定卡泊芬净的血浆水平。第 14 天和第 29 天的谷值和峰值分别为 3.55 和 3.34mg/L，9.28 和 9.49mg/L，结果显示：（1）PK 参数仅略高于以前在健康志愿者和未接受 TIPS 的 A 级肝硬化患者中的报告结果，（2）TIPS 降低前后的暴露情况相似。这种有限的暴露增加预计与毒性无关。
当治疗患有 TIPS 并患有 IFI 的患者时，卡泊芬净是唑类药物的安全替代药物。
