Lempers Vincent J C, Martial Lisa C, Schreuder Michiel F, Blijlevens Nicole M, Burger David M, Aarnoutse Rob E, Brüggemann Roger J M
Radboud university medical center, Department of Pharmacy, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Radboud university medical center, Amalia Children's Hospital, Department of Pediatric Nephrology, Nijmegen, The Netherlands.
Curr Opin Pharmacol. 2015 Oct;24:38-44. doi: 10.1016/j.coph.2015.07.002. Epub 2015 Jul 25.
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.
在移植患者中，管理唑类抗真菌药（氟康唑、伊曲康唑、泊沙康唑和伏立康唑）与免疫抑制剂（环孢素、他克莫司、依维莫司和西罗莫司）之间的药物相互作用（DDIs）仍然具有挑战性，因为免疫抑制剂浓度改变的影响会使患者面临毒性或移植排斥的高风险。因此，临床医生要将免疫抑制剂浓度维持在理想的治疗范围内是一项复杂的任务，这需要针对患者采取高度个体化的方法。我们提供了重要工具，用于充分评估导致免疫抑制剂这种药代动力学变异性的药物相互作用。针对这些临床相关的药物相互作用，提供了一种逐步评估方法及后续管理选项，包括一个决策流程图，以实现最佳处理。
