Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients
Abstract
:1. Introduction
2. Drug–Drug Interactions
3. Adverse Reactions
3.1. Hepatic
3.2. Central Nervous System and Visual Disturbances
3.3. Cardiovascular System
3.4. Integumentary System
3.5. Musculoskeletal System
3.6. Endocrine System
4. Pharmacokinetic Considerations and the Role of Therapeutic Drug Monitoring
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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CYP2C8/CYP2C9 | CYP2C19 | CYP3A4 | P-Glycoprotein | |||||
---|---|---|---|---|---|---|---|---|
Inhibitor | Substrate | Inhibitor | Substrate | Inhibitor | Substrate | Inhibitor | Substrate | |
Isavuconazole | − | − | − | − | + | ++ | + | − |
Posaconazole | − | − | − | − | +/++ | − | ++ | ++ |
Voriconazole | ++ | + | ++ | ++ | ++ | ++ | − | − |
Hepatic | CentralNervous | Cardiovascular | Integumentary | Musculoskeletal | Endocrine | |
---|---|---|---|---|---|---|
Isavuconazole | + | − | − (decreases QT) | − | − | − |
Posaconazole | + | − | +/− (may increase QT) | − | − | + |
Voriconazole | ++ | ++ | + (increases QT) | ++ | ++ | − |
Evidence for Therapeutic Drug Monitoring | Proposed Serum Target for Efficacy | Proposed Serum Target for Toxicity | Guideline Recommendations for Serum Targets | ||||
---|---|---|---|---|---|---|---|
Prophylaxis | Treatment | AST | IDSA | ISHLT | |||
Isavuconazole | −/+ | * | * | * | 2000–3000 ng/mL ** | * | * |
Posaconazole | Oral suspension: +++ Delayed-release tablet: ++ | >700 ng/mL trough | >1250 ng/mL trough | *** | Treatment: >1000–1250 ng/mL | * | Prophylaxis: >700 ng/mL Treatment: >1250 ng/mL |
Voriconazole | +++ | ≥1000 ng/mL trough | ≥1000 ng/mL trough | ≤5500 ng/mL trough | Treatment: 1000–5500 ng/mL **** | Treatment: >1000–1500 to <5000–6000 ng/mL | Prophylaxis and Treatment: 1000–2000 to 4000–5000 ng/mL |
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Klatt, M.E.; Eschenauer, G.A. Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients. J. Fungi 2021, 7, 76. https://doi.org/10.3390/jof7020076
Klatt ME, Eschenauer GA. Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients. Journal of Fungi. 2021; 7(2):76. https://doi.org/10.3390/jof7020076
Chicago/Turabian StyleKlatt, Megan E., and Gregory A. Eschenauer. 2021. "Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients" Journal of Fungi 7, no. 2: 76. https://doi.org/10.3390/jof7020076