PDF(Pubmed)
Abstract：
UNASSIGNED: Voriconazole is primarily metabolized by CYP2C19 and CYP3A4. Drug interactions that affect this pathway can alter its plasma exposures, resulting in untargeted voriconazole concentrations.
UNASSIGNED: In this case report, we describe the case of a 64-year-old man who was treated for non-Hodgkin\'s lymphoma with continuous glucocorticoids co-administrated with voriconazole against invasive pulmonary aspergillosis. A decrease in trough concentration (Cmin) of voriconazole was observed and related with co-administration of dexamethasone in the patient carrying the CYP2C19 *1*2 genotype: voriconazole Cmin/dose ratios of 0.018 (0.1 mg L-1/5.7 mg kg-1 day-1), 0.18 (1 mg L-1/5.7 mg kg-1 day-1), and 0.23 (2 mg L-1/8.6 mg kg-1 day-1) at dexamethasone doses of 20, 12.5, and 2.5 mg, respectively. Sub-therapeutic voriconazole Cmin was associated with high- and moderate-dose dexamethasone (20 and 12.5 mg), leading to failure of antifungal treatment.
UNASSIGNED: The extent of voriconazole-dexamethasone interaction was determined by the dose of dexamethasone and associated with the CYP2C19 *1*2 genotype. Therapeutic drug monitoring of voriconazole is necessary to avoid clinically relevant interactions for optimal antifungal therapy.
UNASSIGNED: In this case report, we describe the case of a 64-year-old man who was treated for non-Hodgkin\'s lymphoma with continuous glucocorticoids co-administrated with voriconazole against invasive pulmonary aspergillosis. A decrease in trough concentration (Cmin) of voriconazole was observed and related with co-administration of dexamethasone in the patient carrying the CYP2C19 *1*2 genotype: voriconazole Cmin/dose ratios of 0.018 (0.1 mg L-1/5.7 mg kg-1 day-1), 0.18 (1 mg L-1/5.7 mg kg-1 day-1), and 0.23 (2 mg L-1/8.6 mg kg-1 day-1) at dexamethasone doses of 20, 12.5, and 2.5 mg, respectively. Sub-therapeutic voriconazole Cmin was associated with high- and moderate-dose dexamethasone (20 and 12.5 mg), leading to failure of antifungal treatment.
UNASSIGNED: The extent of voriconazole-dexamethasone interaction was determined by the dose of dexamethasone and associated with the CYP2C19 *1*2 genotype. Therapeutic drug monitoring of voriconazole is necessary to avoid clinically relevant interactions for optimal antifungal therapy.
摘要：
■伏立康唑主要由CYP2C19和CYP3A4代谢。影响该途径的药物相互作用可以改变其血浆暴露，导致未靶向的伏立康唑浓度。
■在此案例报告中，我们描述了一例64岁的男性患者，他接受了非霍奇金淋巴瘤的治疗，同时使用持续的糖皮质激素与伏立康唑联合治疗侵袭性肺曲霉病。观察到伏立康唑的谷浓度（Cmin）降低，并且与携带CYP2C19*1*2基因型的患者的地塞米松共同给药有关：伏立康唑Cmin/剂量比为0.018（0.1mgL-1/5.7mgkg-1天-1），0.18（1mgL-1/5.7mgkg-1天），和0.23（2mgL-1/8.6mgkg-1day-1）在地塞米松剂量为20、12.5和2.5mg时，分别。亚治疗伏立康唑Cmin与高剂量和中等剂量地塞米松（20和12.5mg）相关，导致抗真菌治疗失败。
■伏立康唑-地塞米松相互作用的程度取决于地塞米松的剂量，并与CYP2C19*1*2基因型相关。伏立康唑的治疗药物监测对于避免临床相关的相互作用是必要的，以实现最佳的抗真菌治疗。
■在此案例报告中，我们描述了一例64岁的男性患者，他接受了非霍奇金淋巴瘤的治疗，同时使用持续的糖皮质激素与伏立康唑联合治疗侵袭性肺曲霉病。观察到伏立康唑的谷浓度（Cmin）降低，并且与携带CYP2C19*1*2基因型的患者的地塞米松共同给药有关：伏立康唑Cmin/剂量比为0.018（0.1mgL-1/5.7mgkg-1天-1），0.18（1mgL-1/5.7mgkg-1天），和0.23（2mgL-1/8.6mgkg-1day-1）在地塞米松剂量为20、12.5和2.5mg时，分别。亚治疗伏立康唑Cmin与高剂量和中等剂量地塞米松（20和12.5mg）相关，导致抗真菌治疗失败。
■伏立康唑-地塞米松相互作用的程度取决于地塞米松的剂量，并与CYP2C19*1*2基因型相关。伏立康唑的治疗药物监测对于避免临床相关的相互作用是必要的，以实现最佳的抗真菌治疗。
