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KMID : 0869620130300050426
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Journal of Korean Society of Hospital Pharmacists
2013 Volume.30 No. 5 p.426 ~ p.438
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Drug Interaction between Cyclosporine and Voriconazole versus Cyclosporine and Fluconazole in Allogenic Hepatopoietic Stem Cell Transplantation
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Kim Bo-Bae
Kim Sung-Hwan
Kim Kwi-Suk
Lee Yong-Hwa
Kim Hyang-Suk
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Abstract
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Voriconazole and fluconazole are azole antifungal agents which the 2010 IDSA (Infectious Diseases Society of America) guideline of cancer neutropenic fever has recommended to use for fungal prophylaxis in hematopoietic stem cell transplantation. However, these agents are known to have an interaction with immunosuppressants such as calcineurin inhibitors, and to elevate the serum calcineurin inhibitors level. The goal of this study was to compare the drug interaction between voriconazole and cyclosporine with fluconazole and cyclosporine. Further, the we compared the renal function after the drug interactions. Fifty-nine patients were enrolled in this study from January 2007 to August 2011. Eleven patients received voriconazole, and forty-eight patients received fluconazole. In this study, there is a difference in cyclosporine dose among patients hence, we calculated the C/D ratio [(ng/mL)/(mg/kg)]. C/D ratio is represented as the serum trough level of cyclosporine when it is administered 1 mg/kg in patients. Peak day means the day that the C/D ratio reaches its peak value. The C/D ratio of the voriconazole group was 209.90±176.38 [(ng/mL)/(mg/kg)] and was higher than 129.36±38.20[(ng/mL)/(mg/kg)], the value of the fluconazole group. However, the peak day of the voriconazole group was 14.82±7.96 days and was slower than that of the fluconazole group. The alteration of the renal function test value was higher in the voriconazole group. Howerer, only BUN showed a significant difference between the two groups. There was no correlation between the C/D ratio and renal panel.
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KEYWORD
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Cyclosporine, Voriconazole, Fluconazole, Allogenic hematopoietic stem cell transplantation
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