José Ramón Azanza,Servicio de Farmacología Clínica. Clínica Universitaria de Navarra. Pamplona. Spain.
Rev Esp Quimioter. 2023 Jun;36(3):236-258. doi: 10.37201/req/013.2023. Epub 2023 Apr 5.
The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.
抗真菌药物的治疗和预防用途，特别是在接受血液肿瘤治疗的患者中，几乎是一种常规治疗。任何预防或治疗曲霉菌或毛霉菌感染的尝试都需要使用一些唑类药物，包括伏立康唑、泊沙康唑和伊曲康唑，这些药物因其对这些病原体的活性而被认为是有效的。一个非常相关的方面是与用于治疗血液肿瘤的抗肿瘤药物之一联合使用时的潜在药物相互作用风险，可能会导致严重的并发症。在这方面，阿卡卢替尼、硼替佐米、博舒替尼、卡非佐米、环磷酰胺、环孢素 A、达沙替尼、杜韦利昔布、吉特替尼、格拉斯吉布、伊布替尼、伊马替尼、尼洛替尼、泊那替尼、泼尼松、鲁索利替尼、他克莫司、全反式维甲酸、三氧化二砷、维奈托克或长春碱类中的任何一种，都是风险的明确例子，在某些情况下是因为它们的清除率降低，而在其他情况下则是因为 QTc 延长的风险增加，当首选药物是伏立康唑或泊沙康唑时，这种情况尤为明显。
