WHO IS AT RISK OF ANTIFUNGAL DDIs?
Antifungal agents are known to interact with many drugs. Over 2,600 potential DDIs are included in the antifungal drug interaction database, of which more than 540 could be severe.5 If undetected, DDIs can lead to patient harm or to potentially fatal adverse events.4
Patients at high risk of an IFI and who are on multiple therapies for their underlying disease may be more likely to be at risk of DDIs, for example:4-6
- Patients admitted to the ICU: Underlying conditions, certain procedures and medications all increase the risk of IFIs for patients in the ICU.3,9 These patients may also be more likely to experience a DDI due to the large number of medications they may be on, complexity of the prescribed pharmacotherapy, disease severity and impact of potential organ failure.10
- Patients with haematological malignancies: Patients undergoing treatment for haematological malignancies are often extensively immunosuppressed, increasing their risk of developing IFIs.2, 11-13 Concomitant use of antifungals, such as azoles, and targeted haemato-oncology therapies can result in a number of clinically relevant DDIs.14-17 Caution is advised for the concurrent use of antineoplastic agents with liposomal amphotericin B.18
- Patients with HIV/AIDS: A depletion in CD4+ T cell count, typicially seen in HIV/AIDs patients, can increase the risk of IFIs.19,20 Antiretrovirals are used as a treatment regimen in these patients. However, antiretrovirals can interact with some azoles, resulting in a number of DDIs.21
- Patients undergoing transplantations: Some nephrotoxic medications administered to prevent graft rejection in transplantation patients may interact with some antifungal agents, such as liposomal amphotericin B, when used concurrently. This may increase the risk of drug-induced renal toxicity in patients.18*
Due to the complexity of concurrent medication regimens in such patients, knowledge of antifungal DDIs and their underlying mechanisms is vital to ensure the selection of effective and well tolerated therapy.6