Posney Elizabeth, Barry Chelsea, Verlinden Nathan J, Veasey Tara
Department of Pharmacy, Allegheny General Hospital, Pittsburgh, Pennsylvania.
JHLT Open. 2023 Dec 24;4:100048. doi: 10.1016/j.jhlto.2023.100048. eCollection 2024 May.
Antifungal prophylaxis postheart transplant (HT) may include voriconazole or clotrimazole, which interact with tacrolimus. There is no guidance for tacrolimus adjustment when transitioning from voriconazole to clotrimazole; therefore, this study evaluates tacrolimus concentration/dose (C/D) ratio on voriconazole compared to clotrimazole. This retrospective, single-center analysis included HT recipients (February 2016-September 2021) who received tacrolimus and voriconazole followed by clotrimazole. Tacrolimus C/D ratio was compared on voriconazole vs clotrimazole, and on clotrimazole vs postantifungal discontinuation. Seventy-two patients were included. The median (interquartile range) tacrolimus C/D ratio was 41% (1.7-fold) lower after transition from voriconazole to clotrimazole [5.1 (3.5, 7.7) vs 3.0 (2.0, 4.6) (ng/ml)/(mg/day), < 0.001], but there was no difference in tacrolimus C/D ratio on clotrimazole vs postantifungal discontinuation [3.0 (2.0, 4.6) vs 2.7 (1.9, 3.7) (ng/ml)/(mg/day), = 0.1]. These data indicate that a 70% tacrolimus dose increase may be appropriate when transitioning from voriconazole to clotrimazole in HT recipients.
心脏移植（HT）后的抗真菌预防用药可能包括伏立康唑或克霉唑，这两种药物会与他克莫司相互作用。从伏立康唑转换为克霉唑时，对于他克莫司的调整尚无指导建议；因此，本研究评估了与克霉唑相比，伏立康唑对他克莫司浓度/剂量（C/D）比值的影响。这项回顾性单中心分析纳入了2016年2月至2021年9月期间接受他克莫司和伏立康唑治疗，随后改用克霉唑的心脏移植受者。比较了伏立康唑与克霉唑治疗时以及克霉唑治疗与停用抗真菌药物后他克莫司的C/D比值。共纳入72例患者。从伏立康唑转换为克霉唑后，他克莫司C/D比值的中位数（四分位间距）降低了41%（1.7倍）[5.1（3.5，7.7）对3.0（2.0，4.6）（纳克/毫升）/（毫克/天），P<0.001]，但克霉唑治疗与停用抗真菌药物后他克莫司C/D比值无差异[3.0（2.0，4.6）对2.7（1.9，3.7）（纳克/毫升）/（毫克/天），P=0.1]。这些数据表明，心脏移植受者从伏立康唑转换为克霉唑时，他克莫司剂量增加70%可能是合适的。
