Pre-Existing Liver Disease and Toxicity of Antifungals
Abstract
:1. Introduction
2. Antifungal Agents
2.1. Polyenes
2.2. Flucytosine
2.3. Azoles
2.3.1. Fluconazole
2.3.2. Itraconazole
2.3.3. Voriconazole
2.3.4. Posaconazole
2.3.5. Isavuconazole
2.4. Echinocandins
2.4.1. Caspofungin
2.4.2. Micafungin
2.4.3. Anidulafungin
3. Clinical Implications and Future Directions
4. Conclusions
Funding
Conflicts of Interest
References
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Anyone of the Following *: |
---|
ALT elevation ≥ 5 × ULN ¶ |
ALP elevation ≥ 2 × ULN ¶, especially with accompanying elevations in concentrations of 5′-NT or GGT |
ALT elevation ≥ 3 × ULN ¶ and simultaneous TB elevation ≥ 2 × ULN ¶ |
Antifungal Agent | Severity of Hepatic Impairment by Child–Pugh Score | ||
---|---|---|---|
Score 5–6 (Class A) | Score 7–9 (Class B) | Score 10–15 (Class C) | |
AmB preparations | No recommendations available | ||
Flucytosine | No recommendations available, use with caution, TDM recommended Authors’ comment: extra caution when combined with AmB preparations | ||
Fluconazole | No recommendations available, use with caution | ||
Itraconazole | No recommendations available, strongly discouraged unless benefit exceeds risk, use with caution and under close monitoring, TDM is recommended | ||
Voriconazole | 50% reduction of maintenance dosage and TDM are recommended | No recommendations available, use only if benefit outweighs risk, close monitoring and TDM are recommended Authors’ comment: reduction of maintenance dosage to about one-third may be considered | |
Posaconazole | No dosage adjustment is recommended, TDM when oral suspension is used Authors’ comment: TDM may also be considered when tablet or intravenous drug formulation is used | ||
Isavuconazole | No dosage adjustment is recommended | No recommendations available, use only if benefit outweighs risk | |
Caspofungin | No dosage adjustment is recommended | Reduced maintenance dose from 50 mg to 35 mg daily Authors’ comment: in critically ill patients, reduced dosage may lead to decreased drug exposure | No recommendations available |
Micafungin | No dosage adjustment is recommended | US FDA recommends no dosage adjustment, EMA recommends avoidance of its use | |
Anidulafungin | No dosage adjustment is recommended |
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Spernovasilis, N.; Kofteridis, D.P. Pre-Existing Liver Disease and Toxicity of Antifungals. J. Fungi 2018, 4, 133. https://doi.org/10.3390/jof4040133
Spernovasilis N, Kofteridis DP. Pre-Existing Liver Disease and Toxicity of Antifungals. Journal of Fungi. 2018; 4(4):133. https://doi.org/10.3390/jof4040133
Chicago/Turabian StyleSpernovasilis, Nikolaos, and Diamantis P. Kofteridis. 2018. "Pre-Existing Liver Disease and Toxicity of Antifungals" Journal of Fungi 4, no. 4: 133. https://doi.org/10.3390/jof4040133