8 PHARMACOLOGY consult
HEM/ONC TODAY’s tips on pharmaceutical essentials
Comparison of newer antifungal agents
Lisa K. Lohr, PharmD
Lisa K. Lohr, PharmD
trum of activity as well as in mechanism
For more information:
Boucher HW, Groll AH, Chiou CC, Walsh TJ. Newer
systemic antifungal agents: pharmacokinetics, safety
have broad spectrums of activity and effi cacy. Drugs
. 2004; 64:1997-2020.
therapy. The role of these agents, alone
Consideration should be given to About the author:
fungal infections is still being defi ned.
each agent’s potential adverse effects
Lisa K. Lohr, PharmD,
is a clinical pharmacy special-
ist in oncology at Fairview University Medical Center
Not yet approved (under investigation for
treatment and prophylaxis of invasive fungal
Treatment of invasive aspergillosis; treatment of
infections in patients intolerant or refractory
various other Candida infections, included esopha-
prophylaxis of candida infections in high-
to other antifungal therapies. Potential
geal candidiasis, and other Scedosporium and
indications include invasive aspergillus
infections, neutropenic fevers, and azole-re-
A second-generation triazole agent; inhibits fungal
P450-dependent ergosterol synthesis, which dis-
inhibits b-(1,3)-D-glucan synthase which
terol synthesis, which disrupts fungal cell
rupts fungal cell membrane and halts fungal growth.
interferes with fungal cell wall formation.
Candida species (albicans, glabrata, krusei,
Aspergillus species, Candida species, Fusarium
tropicalis, parapsilosis, and others), Asper-
species, Scedosporium apiospermum, Cryptococ-
gillus species (fumigatus, ﬂ avus, niger and
cus neoformans, Histoplasma capsulatum, (not
solani, Rhizopus, zygomycetes, or Trichos-
others), Coccidioides, Fusarium, Histoplas-
Rhizopus arrhizus, not zygomycosis).
Coadministration with terfenadine, astemizole, cis-apride, pimozide (Orap, Teva), quinidine, rifampin, carbamazepine, barbiturates,
ritonavir, efavirenz, rifabutin (Mycobutin, Pharmacia
and Upjohn), ergot alkaloids, or sirolimus (Rapamune, Wyeth).
Hypersensitivity to azoles, severe hepatic cirrhosis
Hypersensitivity to other azole antifungal
Hypersensitivity to caspofungin. Liver dis-
(Child-Pugh Class C), moderate-severe renal dys-
agents. Coadministration with tacrolimus
ease or impairment, myelosuppression.
function (accumulation of IV vehicle – avoid use).
Prophylaxis in HSCT patients: 50 mg IV dailyTreatment of esophageal candidiasis: 100-
6 mg/kg IV Q12h for two doses, then 4 mg/kg IV
Q12h. Can be changed to 200 mg PO Q12h (for
patients >40 kg) or 100 mg PO Q12h (for patients
<40 kg.) Dose can be increased if inadequate re-
Treatment of Candida albicans infections:
sponse. Oral doses are preferably taken on an empty
Treatment of nonalbicans Candida infec-tions: 100 mg IV daily.
Primarily hepatic metabolism, some elimi-
nation unchanged in stool and urine.
For patients with mild to moderate hepatic cirrhosis
For patients with moderate liver disease
(Child-Pugh Class A & B), use normal loading dose,
then reduce to 2 mg/kg IV q12h, then 100 mg PO Q12h
(for patients >40 kg) or 50 mg PO Q12h (for patients
no data regarding the use in patients with
Transient visual disturbances, rash, fever, nausea,
Nausea, vomiting, diarrhea, hyperbilirubi-
vomiting, diarrhea, headache, sepsis, edema, ab-
pain, headache, fatigue, rash, increased
Inhibits CYP2C19, 2C9, 3A4. Can interact with ampre-navir, astemizole, atazanavir (Reyataz, Bristol-Meyers Squibb), atorvastatin, barbiturates, benzodiazepines, calcium channel blockers, carbamazepine, cisapride,
cyclosporine, delavirdine (Rescriptor, Agouron), efa-
virenz, ergot alkaloids, erlotinib (Tarceva, OSI), eryth-
romycin, fosphenytoin, imatinib (Gleevec, Novartis),
lovastatin, nelﬁ navir (Viracept, Agouron), nevirapine, omeprazole, phenytoin, pimozide, quinidine, rifabutin, rifampin, ritonavir, saquinavir, simvastatin, sirolimus, tacrolimus, terfenadine, vinca alkaloids, warfarin.
Material Safety Data Sheet GEL STAIN REMOVER 1. Identification of the material and supplier Trade name of product : GEL STAIN REMOVER : Not regulated. Supplier : ECOLAB PTY LTD (A.B.N. 59 000 449 990) Emergency telephone : 1 800 124 170 number Material uses : Cleaning product Product dilution information : Not applicable Date of issue : 11 April 2012
January 2008 Stop the War on Drugs By Scott Gottlieb, M.D. In December 2005, Eli Lilly pled guilty to a criminal indictment from the Justice Department and paid$36 million in fines and “disgorgement” of its ill-gotten gains. The company’s crime was mounting aconcerted effort to inform doctors that, according to leading medical authorities, the firm’s estrogen-mod-ulating drug Ev