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Titolo:
Enhanced cyclosporine-itraconazole interaction with cola in lung transplant recipients
Autore:
Wimberley, SL; Haug, MT; Shermock, KM; Qu, A; Maurer, JR; Mehta, AC; Schilz, RJ; Gordon, SM;
Indirizzi:
Cleveland Clin Fdn, Dept Pharm HB3, Cleveland, OH 44195 USA Cleveland ClinFdn Cleveland OH USA 44195 rm HB3, Cleveland, OH 44195 USA
Titolo Testata:
CLINICAL TRANSPLANTATION
fascicolo: 2, volume: 15, anno: 2001,
pagine: 116 - 122
SICI:
0902-0063(200104)15:2<116:ECIWCI>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
PHARMACOKINETICS; INFECTION;
Keywords:
aspergillosis; cyclosporine; drug interactions; itraconazole; lung transplant;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
18
Recensione:
Indirizzi per estratti:
Indirizzo: Haug, MT Cleveland Clin Fdn, Dept Pharm HB3, 9500 Euclid Ave, Cleveland, OH 44195 USA Cleveland Clin Fdn 9500 Euclid Ave Cleveland OH USA 44195 195 USA
Citazione:
S.L. Wimberley et al., "Enhanced cyclosporine-itraconazole interaction with cola in lung transplant recipients", CLIN TRANSP, 15(2), 2001, pp. 116-122

Abstract

Background: Invasive aspergillosis is a major cause of morbidity and mortality in lung transplant recipients (LTR), occurring in up to 15% of patients post-transplant. The 14% aspergillus incidence at the Cleveland Clinic Foundation prompted institution of universal prophylaxis with oral itraconazole (ICZ) in 1997. We report our experience with two protocols of ICZ administration in non-cystic fibrosis LTR and the interaction with cyclosporine (CSA). Methods: Group 1 patients (n = 12) were administered ICZ capsules in a fasting or fed state, with or without a histamine-2 (H-2) receptor antagonist or proton pump inhibitor. Group 2 patients (n = 12) received the same protocol as group 1, but in a fed state with a carbonated beverage (cola) to increase acidity in the stomach to enhance absorption of ICZ, The ICZ dose was200 mg/d, given as one daily dose. A historical control group (n = 10) didnot receive chemoprophylaxis with ICZ. CSA daily doses, dose intervals, concentration, cost, and random ICZ levels were documented over a 1-month period of time and compared using generalized estimating equations. Results: The daily CSA mg/kg/d dose decreased over time in all three groups, but no differences were found between the three groups. The CSA dosing interval over time was significantly prolonged in group 2 compared to group 1 or the control group (p less than or equal to 0.003). Over time, there was no difference in CSA concentration between all groups. There was no difference in cost over time between the three groups; however, the mean cost ofCSA therapy was significantly lower in group 2 compared to the control group (p = 0.025). Group 2 administered ICZ with cola had greater random bloodconcentrations of ICZ (p = 0.019). Conclusions: ICZ capsules administered in a fed state with a cola resultedin greater random levels of ICZ, a decrease in cost/d of CSA, and a prolongation of CSA dosing interval. Although daily CSA dosage trended lower in group 2, it did not reach statistical significance. We believe these changesin CSA dosing over time reflect increased absorption of ICZ and recommend verifying ICZ absorption with an itraconazole level. especially when CSA intervals are not prolonged.

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Documento generato il 12/07/20 alle ore 06:34:21