Objetive:

Identify, describe the potential pharmacological interactions of isavuconazole, study the clinical impact of the most relevant ones and establish therapeutic recommendations for those found in hospitalized patients.

Methods:

Retrospective descriptive observational study that included all patients treated with isavuconazole from its marketing until December 2019.

Demographic variables and drugs concomitant to isavuconazole for more than 48 hours received by the patient were collected. The treatments with Lexicomp® were reviewed to detect possible interactions, its mechanism of action was analyzed and it was related to the drugs involved, establishing therapeutic recommendations.

To establish the clinical impact, the medical records of the patients with more severe interactions (D and X for Lexicomp®) were reviewed. In the case of finding any adverse reaction, Horn's algorithm was applied to establish the probability that the effect is produced by the pharmacological interaction.

Results:

84 admissions in 59 patients were analyzed. There were 209 potential interactions in 84.5% of the admissions. The majority, 84.7%, were of a moderate nature (category C), the most frequent with tacrolimus. The main mechanism of action was the inhibitory effect on cytochrome CYP3A4 of isavuconazole (82.8%).

A patient with an increase in alkaline phosphatase coinciding with the concomitant initiation of isavuconazole and clarithromycin was detected. When applying Horn's algorithm, the interaction is considered as possible.

Conclusions:

Potential serious drug interactions were detected in less than 10% of admissions and only one possible adverse reaction associated with this interaction was detected, and it could not be classified as definitive.

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