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Matsuda Y, Nakagawa S, Yano I, Masuda S, Imai S, Yonezawa A, Yamamoto T, Sugimoto M, Tsuda M, Tsuzuki T, Omura T, Nakagawa T, Chen-Yoshikawa TF, Nagao M, Date H, Matsubara K. Effect of Itraconazole and Its Metabolite Hydroxyitraconazole on the Blood Concentrations of Cyclosporine and Tacrolimus in Lung Transplant Recipients. Biol Pharm Bull 2022; 45:397-402. [DOI: 10.1248/bpb.b21-00738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yuya Matsuda
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Shunsaku Nakagawa
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Ikuko Yano
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Satohiro Masuda
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Himeji Dokkyo University
| | - Satoshi Imai
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Atsushi Yonezawa
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Takashi Yamamoto
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Mitsuhiro Sugimoto
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Masahiro Tsuda
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Tetsunori Tsuzuki
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Tomohiro Omura
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Takayuki Nakagawa
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | | | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine
| | - Kazuo Matsubara
- Departments of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
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Imoto Y, Naito T, Miyadera Y, Ono T, Kawakami J. Associations between plasma hydroxylated metabolite of itraconazole and serum creatinine in patients with a hematopoietic or immune-related disorder. Eur J Clin Pharmacol 2020; 77:369-379. [PMID: 33033881 DOI: 10.1007/s00228-020-03010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Serum markers of renal function have not been characterized in patients treated with itraconazole (ITZ). This study aimed to evaluate the associations between plasma ITZ and its hydroxylated metabolite (OH-ITZ) concentrations and serum markers of renal function in patients with hematopoietic or immune-related disorder. METHODS This study enrolled 40 patients with hematopoietic or immune-related disorder who are receiving oral ITZ solution. Plasma concentrations of ITZ and OH-ITZ at 12 h after dosing were determined at steady state. Their relationships with serum levels of creatinine and cystatin C and their estimated glomerular filtration rate (eGFR) were evaluated. RESULTS The free plasma concentration of ITZ had no correlation with serum creatinine and serum creatinine-based estimated glomerular filtration rate (eGFR-cre). The free plasma concentration of OH-ITZ was positively and negatively correlated with serum creatinine and eGFR-cre, respectively. The free plasma concentrations of ITZ and OH-ITZ had no association with serum cystatin C and serum cystatin C-based eGFR. Serum creatinine was higher by 16% after than before starting ITZ treatment, while eGFR-cre was lower by 9.3%. The serum creatinine ratio after/before ITZ treatment was positively correlated with the free plasma concentration of OH-ITZ. The patients co-treated with trimethoprim-sulfamethoxazole had higher serum creatinine. Concomitant glucocorticoid administration did not significantly alter serum cystatin C. CONCLUSIONS Patients with hematopoietic or immune-related disorder treated with oral ITZ had a higher level of serum creatinine. Although serum creatinine potentially increases in conjunction with the free plasma concentration of OH-ITZ, concomitant ITZ administration has a slight impact on the eGFR-cre level in clinical settings.
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Affiliation(s)
- Yumi Imoto
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takafumi Naito
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Yukari Miyadera
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takaaki Ono
- Division of Hematology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Junichi Kawakami
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
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Simultaneous determination of itraconazole and its CYP3A4-mediated metabolites including N-desalkyl itraconazole in human plasma using liquid chromatography-tandem mass spectrometry and its clinical application. J Pharm Health Care Sci 2020; 6:11. [PMID: 32391164 PMCID: PMC7199303 DOI: 10.1186/s40780-020-00167-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background Itraconazole (ITZ), a triazole antifungal agent, is metabolized to hydroxy-ITZ (OH-ITZ), keto-ITZ (KT-ITZ), and N-desalkyl ITZ (ND-ITZ) by cytochrome P450 3A4. The pharmacokinetics of ND-ITZ remain largely unknown due to the lack of an accurate and reliable determination method. This study aimed to develop a simultaneous determination method for ITZ and its three major metabolites including ND-ITZ in human plasma using isocratic liquid chromatography coupled to tandem mass spectrometry and then apply the method in a clinical setting. Methods Plasma specimens were pretreated by protein precipitation with acetonitrile. The supernatant was separated on a 3-μm particle octadecyl silane column (75 × 2.0 mm I.D.) in an isocratic elution of acetonitrile and 5 mM ammonium acetate (pH 6.0) (57:43, v/v). The method was applied to 10 patients treated with oral ITZ. Results The calibration curves of ITZ, OH-ITZ, KT-ITZ, and ND-ITZ were linear over the concentration ranges of 15–1500, 15–1500, 1–100, and 1–100 ng/mL, respectively. The pretreatment recoveries and matrix factors were 90.1–102.2% and 99.1–102.7%. Their intra- and inter-assay accuracies and imprecisions were 94.1–106.7% and 0.3–4.4%. The plasma concentrations of ITZ, OH-ITZ, KT-ITZ, and ND-ITZ 12 h after dosing ranged from 32.5–1127.1, 19.0–1166.7, 1.1–5.4, and 3.5–28.3 ng/mL, respectively, in immunocompromised patients. Conclusions This study developed a simultaneous determination method for concentrations of ITZ and its three metabolites including ND-ITZ in a clinical setting.
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Yoon SJ, Lee K, Oh J, Woo HI, Lee SY. Experience with therapeutic drug monitoring of three antifungal agents using an LC-MS/MS method in routine clinical practice. Clin Biochem 2019; 70:14-17. [DOI: 10.1016/j.clinbiochem.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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Dry powder inhaler formulations of poorly water-soluble itraconazole: A balance between in-vitro dissolution and in-vivo distribution is necessary. Int J Pharm 2018; 551:103-110. [PMID: 30217767 DOI: 10.1016/j.ijpharm.2018.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 01/30/2023]
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Simultaneous quantification of systemic azoles and their major metabolites in human serum by HPLC/PDA: role of azole metabolic rate. Diagn Microbiol Infect Dis 2018; 92:78-83. [DOI: 10.1016/j.diagmicrobio.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/07/2018] [Accepted: 04/06/2018] [Indexed: 01/12/2023]
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Dragojević-Simić V, Kovačević A, Jaćević V, Rančić N, Djordjević S, Kilibarda V, Mikov M, Bokonjić D. Bioequivalence study of two formulations of itraconazole 100 mg capsules in healthy volunteers under fed conditions: a randomized, three-period, reference-replicated, crossover study. Expert Opin Drug Metab Toxicol 2018; 14:979-988. [PMID: 30028640 DOI: 10.1080/17425255.2018.1503649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the bioequivalence of two itraconazole 100 mg capsule formulations. RESEARCH DESIGN AND METHODS The single-center, open-label, randomized, three-period, three-sequence, reference-replicated, cross-over study included 38 healthy subjects under fed conditions. In each study period (separated by a 14-day washout), a single oral dose of the test (T) or reference (R) product was administered. Blood samples were collected at pre-dose and up to 72.0 h after administration. The calculated pharmacokinetic parameters, based on the plasma concentrations of itraconazole and hydroxy itraconazole, were AUC0-72h, AUC0-∝, Cmax, Tmax, T1/2 and Kel. RESULTS The 90% CI for the test/reference geometric means ratio for the parent compound, itraconazole, was in the range from 85.29% to 116.07% for AUC0-72h. Since the coefficient of variation (CV) for the reference product was 44.95% for Cmax, the 90% CI for this parameter for itraconazole was 93.49-133.78%, which was within the proposed limits of the EMA for bioequivalence of 72.15-138.59%. During the study, 4 subjects encountered a total of 14 mild adverse events. CONCLUSIONS The use of the reference-scaling approach with 3-period design (TRR, RTR, and RRT) was an efficient way to demonstrate that two commercially available oral itraconazole formulations met the predetermined bioequivalence criteria.
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Affiliation(s)
- Viktorija Dragojević-Simić
- a Centre for Clinical Pharmacology , Military Medical Academy , Belgrade , Serbia.,b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
| | - Aleksandra Kovačević
- a Centre for Clinical Pharmacology , Military Medical Academy , Belgrade , Serbia.,b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
| | - Vesna Jaćević
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia.,c National Poison Control Centre , Military Medical Academy , Belgrade , Serbia.,d Department of Chemistry, Faculty of Science , University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Nemanja Rančić
- a Centre for Clinical Pharmacology , Military Medical Academy , Belgrade , Serbia.,b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
| | - Snežana Djordjević
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia.,c National Poison Control Centre , Military Medical Academy , Belgrade , Serbia
| | - Vesna Kilibarda
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia.,c National Poison Control Centre , Military Medical Academy , Belgrade , Serbia
| | - Momir Mikov
- e Institute for Pharmacology, Clinical Pharmacology and Toxicology , University of Novi Sad, Faculty of Medicine , Novi Sad , Serbia
| | - Dubravko Bokonjić
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
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In vivo evaluation of the efficacy, toxicity and biodistribution of PLGA-DMSA nanoparticles loaded with itraconazole for treatment of paracoccidioidomycosis. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ferrer R, Mateu X, Maseda E, Yébenes JC, Aldecoa C, De Haro C, Ruiz-Rodriguez JC, Garnacho-Montero J. Non-oncotic properties of albumin. A multidisciplinary vision about the implications for critically ill patients. Expert Rev Clin Pharmacol 2017; 11:125-137. [PMID: 29219627 DOI: 10.1080/17512433.2018.1412827] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Effective resuscitation with human albumin solutions is achieved with less fluid than with crystalloid solutions. However, the role of albumin in today's critical care unit is also linked to its multiple pharmacological effects. Areas covered: The potential clinical benefits of albumin in select populations of critically ill patients like sepsis seem related to immunomodulatory and anti-inflammatory effects, antibiotic transportation and endothelial stabilization. Albumin transports many drugs used in critically ill patients. Such binding to albumin is frequently lessened in critically ill patients with hypoalbuminemia. These changes could result in sub-optimal treatment. Albumin has immunomodulatory capacity by binding several bacterial products. Albumin also influences vascular integrity, contributing to the maintenance of the normal capillary permeability. Moreover, the albumin molecule encompasses several antioxidant properties, thereby significantly reducing re-oxygenation injury, which is especially important in sepsis. In fact, most studies of albumin administration are a combination of a degree of resuscitation with a degree of maintenance or supplementation of albumin. Expert commentary: The potential clinical benefits of the use of albumin in selected critically ill patients such as sepsis seem related to its immunomodulatory and anti-inflammatory effects, antioxidant properties, antibiotic transportation and endothelial stabilization. Additional studies are warranted to further elucidate the underlying physiologic and molecular rationale.
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Affiliation(s)
- Ricard Ferrer
- a Intensive Care Department , Vall d'Hebron University Hospital; Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d'Hebron Institut de Recerca , Barcelona , Spain
| | - Xavier Mateu
- b Pharmacy Department , Hospital del Mar , Barcelona , Spain
| | - Emilio Maseda
- c Anesthesiology and Resuscitation Department , La Paz University Hospital , Madrid , Spain
| | | | - César Aldecoa
- e Anesthesiology and Resuscitation Department , Río Hortega Hospital , Valladolid , Spain
| | | | - Juan Carlos Ruiz-Rodriguez
- a Intensive Care Department , Vall d'Hebron University Hospital; Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d'Hebron Institut de Recerca , Barcelona , Spain
| | - José Garnacho-Montero
- g Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS) , Sevilla , Spain
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Liang C, Shan Q, Zhong J, Li W, Zhang X, Wang J, Cao C, Zeng Z. Pharmacokinetics and bioavailability of itraconazole oral solution in cats. J Feline Med Surg 2016; 18:310-4. [PMID: 25916686 PMCID: PMC11112252 DOI: 10.1177/1098612x15581408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to describe the pharmacokinetics and bioavailability of itraconazole (ITR) oral solution in healthy cats. METHODS The pharmacokinetics of ITR were studied in eight healthy, fasted cats after a single intravenous (IV) and oral (PO) administration at a dose of 5 mg/kg, in a two-period crossover design study. Blood was obtained at predetermined intervals for the determination of ITR concentrations with high-performance liquid chromatography. Pharmacokinetic characterisation was performed by a non-compartmental method using WinNonlin 5.2.1. RESULTS After IV administration, the major pharmacokinetic parameters were as follows (mean ± SD): terminal elimination half-life (T1/2λz ) 15.8 ± 1.88 h; area under the curve from time zero to infinity (AUC0-∞ ) 13.9 ± 3.17 h·μg/ml; total body clearance 0.37 ± 0.08 l/h/kg; apparent volume of distribution 8.51 ± 1.92 l/kg; mean residence time 20.6 ± 3.95 h. After PO administration, the principal pharmacokinetic parameters were as follows (mean ± SD): T1/2λz 15.6 ± 3.20 h; AUC0-∞ 7.94 ± 2.83 h·μg/ml; peak concentration 0.70 ± 0.14 μg/ml; time of peak 1.43 ± 0.53 h. The absolute bioavailability of ITR oral solution after oral administration was 52.1 ± 11.6%. CONCLUSIONS AND RELEVANCE The disposition of ITR oral solution in cats is characterised by a long terminal half-life, a short peak time and moderate bioavailability.
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Affiliation(s)
- Chaoping Liang
- National Reference Laboratory of Veterinary Drug Residues (SCAU), College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Qi Shan
- Pearl River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Guangzhou, China
| | - Jialian Zhong
- National Reference Laboratory of Veterinary Drug Residues (SCAU), College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Wei Li
- National Reference Laboratory of Veterinary Drug Residues (SCAU), College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Xiufeng Zhang
- National Reference Laboratory of Veterinary Drug Residues (SCAU), College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Jing Wang
- Guangzhou Senya Animal's Pharmaceutical Co Ltd, Guangzhou, China
| | - Changfu Cao
- National Reference Laboratory of Veterinary Drug Residues (SCAU), College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Zhenling Zeng
- National Reference Laboratory of Veterinary Drug Residues (SCAU), College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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Mino Y. [Optimization of Immunosuppression and the Prevention of Fungal Infection in Autoimmune Diseases]. YAKUGAKU ZASSHI 2015; 135:1123-7. [PMID: 26423867 DOI: 10.1248/yakushi.15-00193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mycophenolate mofetil (MMF) has recently been reported to be effective in the treatment of systemic lupus erythematosus (SLE). The therapeutic range of mycophenolic acid (MPA) and its 7-O-glucuronide (MPAG), and factors affecting their pharmacokinetics, remain to be clarified. The influence of the pharmacokinetics of MPA and MPAG on the activity of inosine 5'-monophosphate dehydrogenase (IMPDH), a target of the MPA, also remains to be revealed. The pharmacokinetic variability of hydroxy-itraconazole (OH-ITZ), an active metabolite of itraconazole frequently co-administered with immunosuppressants in immunocompromised patients, is not fully known. The aim of this study was to establish the optimal dosage and administration of immunosuppressants and antifungal agents. MMF improved clinical laboratory markers and reduced prednisolone dosage in 31 SLE patients, with a pre-dose plasma concentration of MPA and MPAG in the interquartile ranges of 0.94-2.96 and 18.6-53.7 μg/mL, respectively. Renal function and co-administered metal influenced the pharmacokinetics of MPA and MPAG in 31 SLE patients in the remission maintenance phase. IMPDH activity was induced in 29 SLE patients receiving the MMF therapy. This induction was dependent on the plasma concentration of MPAG, but not MPA. In addition, IMPDH activity was negatively correlated with complement fraction C3. MPA exposure and disease activity in SLE patients may determine IMPDH activity. The pharmacokinetic variability of OH-ITZ was associated with saturated metabolism to keto-itraconazole, serum concentration of albumin, and renal function in 46 immunocompromised patients. Prevention of fungal infections and drug-drug interactions in immunocompromised patients can be obtained by considering these identified confounding factors.
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Affiliation(s)
- Yasuaki Mino
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine
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Krautwald-Junghanns ME, Vorbrüggen S, Böhme J. Aspergillosis in Birds: An Overview of Treatment Options and Regimens. J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2015.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Impact of inflammation and concomitant glucocorticoid administration on plasma concentration of triazole antifungals in immunocompromised patients. Clin Chim Acta 2015; 441:127-32. [DOI: 10.1016/j.cca.2014.12.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/26/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022]
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Therapeutic drug monitoring for triazoles: A needs assessment review and recommendations from a Canadian perspective. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 25:327-43. [PMID: 25587296 PMCID: PMC4277162 DOI: 10.1155/2014/340586] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Invasive fungal infections cause significant morbidity and mortality in patients with concomitant underlying immunosuppressive diseases. The recent addition of new triazoles to the antifungal armamentarium has allowed for extended-spectrum activity and flexibility of administration. Over the years, clinical use has raised concerns about the degree of drug exposure following standard approved drug dosing, questioning the need for therapeutic drug monitoring (TDM). Accordingly, the present guidelines focus on TDM of triazole antifungal agents. A review of the rationale for triazole TDM, the targeted patient populations and available laboratory methods, as well as practical recommendations based on current evidence from an extended literature review are provided in the present document.
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Saito W, Shishikura Y, Nishimaki K, Kikuchi T, Sasamori K, Kikuchi Y, Miki H. [Two cases of pulmonary aspergilosis, which deteriorated with generic itraconazole]. ACTA ACUST UNITED AC 2014; 88:469-73. [PMID: 25199382 DOI: 10.11150/kansenshogakuzasshi.88.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We experienced two cases of pulmonary aspergillosis, which deteriorated during treatment with generic itraconazole (ITCZ) because of low plasma concentration. One case was chronic pulmonary aspergillosis and the other was allergic bronchopulmonary aspergillosis (ABPA). Treatment of both cases was started with a brand-name-ITCZ, and changed to a generic ITCZ. Deterioration of pulmonary aspergillosis occurred after 8 months and 9 months from change to generic ITCZ respectively. In the first case, the ITCZ-plasma concentration was 46.9 ng/mL and of OH-ITCZ 96.5 ng/mL with generic ITCZ at the dose of 300 mg/day, but increased to 1,559.7 ng/mL and to 2,485.0 ng/mL with the brand-name-ITCZ 300 mg/day, respectively. In the second case, the ITCZ-plasma concentration was 27.2 ng/mL and of OH-ITCZ 20.1 ng/mL with 150 mg/day for generic ITCZ, but reached 857.3 ng/mL and to 1,144.2 ng/ml with the brand-name-ITCZ 300 mg/day, respectively. After treatment failure, the first case was changed to voriconazole, then brand-name-ITCZ 300 mg/day, and the second case to the brand-name-ITCZ 300 mg/day, with successful clinical course. Plasma concentrations of ITCZ can differ significantly depending on the patient or type of ITCZ. The ITCZ-plasma concentration should be controlled after changing from a brand-name-ITCZ to a generic ITCZ.
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The relationship between the success rate of empirical antifungal therapy with intravenous itraconazole and clinical parameters, including plasma levels of itraconazole, in immunocompromised patients receiving itraconazole oral solution as prophylaxis: a multicenter, prospective, open-label, observational study in Korea. Ann Hematol 2013; 93:33-42. [DOI: 10.1007/s00277-013-1826-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
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