Chen Chen, Dong Yan, Song Ningxia, Qi Jian, Wang Juandong
Department of Clinical Pharmacy, The Second Hospital of Shandong University, Jinan, China.
Department of Hematology, The Second Hospital of Shandong University, Jinan, China.
Medicine (Baltimore). 2025 Jul 18;104(29):e42927. doi: 10.1097/MD.0000000000042927.
It has been demonstrated that azole antifungal agents can significantly increase the plasma concentration of dasatinib. Therefore, it is recommended to reduce the dasatinib dose to 20 to 40 mg daily for patients receiving voriconazole. However, the safety of coadministering dasatinib and voriconazole remains unclear.
A 49-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia and invasive pulmonary aspergillosis reported dyspnea during therapy with reduced-dose dasatinib and standard-dose voriconazole.
Echocardiography revealed pleural effusion and a mean pulmonary arterial pressure of 40 mm Hg, suggesting pulmonary arterial hypertension.
Dasatinib was discontinued and flumatinib was initiated.
The patient's mean pulmonary arterial pressure was monitored and gradually normalized.
Despite recommendations to reduce the dasatinib dose to 20 to 40 mg daily for patients on voriconazole, the enhanced effect of dasatinib due to voriconazole coadministration may contribute to the development of pulmonary arterial hypertension. Regular echocardiography follow-up is essential for patients concurrently taking azole antifungal agents.
已证明唑类抗真菌药物可显著提高达沙替尼的血浆浓度。因此，对于接受伏立康唑治疗的患者，建议将达沙替尼剂量减至每日20至40毫克。然而，达沙替尼与伏立康唑联合使用的安全性仍不明确。
一名49岁患有费城染色体阳性急性淋巴细胞白血病和侵袭性肺曲霉病的女性，在接受减量达沙替尼和标准剂量伏立康唑治疗期间出现呼吸困难。
超声心动图显示有胸腔积液，平均肺动脉压为40毫米汞柱，提示肺动脉高压。
停用达沙替尼并开始使用氟马替尼。
对患者的平均肺动脉压进行监测并逐渐恢复正常。
尽管建议对服用伏立康唑的患者将达沙替尼剂量减至每日20至40毫克，但伏立康唑联合使用导致达沙替尼作用增强可能会促使肺动脉高压的发生。对于同时服用唑类抗真菌药物的患者，定期进行超声心动图随访至关重要。
