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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).
Pregnancy.
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.
OCTOBER 2005

Source: http://www.infectiousdiseasenews.com/200510/pharmconsult.pdf