Pharmacokinetic interaction between voriconazole and ciclosporin A following allogeneic bone marrow transplantation

J Antimicrob Chemother. 2004 Jan;53(1):113-4. doi: 10.1093/jac/dkh022. Epub 2003 Dec 4.

Abstract

Voriconazole is a novel antifungal triazole that undergoes extensive oxidative metabolization involving several CYP450 isoenzymes. We report the case of a 14-year-old patient who received voriconazole concomitant with ciclosporin A as secondary antifungal prophylaxis after bone marrow transplantation. Temporary discontinuation of voriconazole due to worsening liver function tests (LFTs) resulted in a sudden drop of ciclosporin A trough levels in blood. Ciclosporin A trough levels returned to baseline following normalization of LFTs and re-institution of voriconazole. This report emphasizes the need for careful monitoring and dose adjustments of ciclosporin A in patients receiving concomitant voriconazole, and in whom voriconazole is discontinued in order to prevent subtherapeutic ciclosporin A levels with the potential consequence of graft-versus-host disease.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / pharmacokinetics*
  • Antifungal Agents / therapeutic use
  • Bone Marrow Transplantation*
  • Cyclosporine / administration & dosage
  • Cyclosporine / pharmacokinetics*
  • Cyclosporine / therapeutic use
  • Drug Interactions
  • Female
  • Humans
  • Leukemia, Myeloid, Acute / therapy
  • Mycoses / prevention & control*
  • Pyrimidines / administration & dosage
  • Pyrimidines / pharmacokinetics*
  • Pyrimidines / therapeutic use
  • Triazoles / administration & dosage
  • Triazoles / pharmacokinetics*
  • Triazoles / therapeutic use
  • Voriconazole

Substances

  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Cyclosporine
  • Voriconazole