Lomaestro B M, Piatek M A
Department of Pharmacy, Albany Medical Center, NY 12208, USA.
Ann Pharmacother. 1998 Sep;32(9):915-28. doi: 10.1345/aph.17271.
To review and update the incidence, mechanism, and clinical relevance of drug interactions with itraconazole, ketoconazole, and fluconazole.
Literature was identified by MEDLINE search (from January 1990 to May 1997) using the name of each antifungal and the term "interaction" as MeSH headings. Abstracts were identified by literature citation and by review of Interscience Conference on Antimicrobial Agents and Chemotherapy from 1995 to 1996.
Randomized, controlled, double-blind studies were emphasized; however, uncontrolled studies and case reports were also included. In vitro data were selected from literature review and citations.
Data were evaluated with respect to study design, clinical relevance, magnitude of interaction, and recommendations provided.
The incidence of fungal infections and consequent azole antifungal usage continues to increase. By virtue of their antifungal mechanism (i.e., inhibition of cytochrome P450 fungal enzyme systems), azoles have been investigated and implicated in several drug interactions. The magnitude of interactions can vary from trivial to potentially fatal, and also vary with specific azole and interactant.
The azole antifungal agents represent a commonly used class of agents with a broad range of potential interactions. Recent data have increased our understanding of drug--drug interactions with azoles. Pharmacists are in a unique position to identify these interactions and to intervene to decrease their morbidity and improve patient care.
回顾并更新与伊曲康唑、酮康唑及氟康唑发生药物相互作用的发生率、机制及临床相关性。
通过MEDLINE检索（1990年1月至1997年5月）确定文献，使用每种抗真菌药的名称及“相互作用”作为医学主题词。通过文献引用以及查阅1995年至1996年抗菌药物和化疗跨学科会议的资料确定摘要。
重点强调随机、对照、双盲研究；但也纳入了非对照研究和病例报告。体外数据从文献综述及引用中选取。
根据研究设计、临床相关性、相互作用程度及提供的建议对资料进行评估。
真菌感染的发生率及随后唑类抗真菌药的使用持续增加。由于其抗真菌机制（即抑制细胞色素P450真菌酶系统），唑类已被研究并涉及多种药物相互作用。相互作用的程度可从轻微到潜在致命，且因特定的唑类及相互作用药物而异。
唑类抗真菌药是一类常用药物，具有广泛的潜在相互作用。最新数据增进了我们对唑类药物-药物相互作用的理解。药剂师在识别这些相互作用并进行干预以降低其发病率及改善患者护理方面具有独特地位。
