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JAC Advance Access published online on December 4, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh022
© 2003 by The British Society for Antimicrobial Chemotherapy
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© 2003 The British Society for Antimicrobial Chemotherapy

Brief report

Pharmacokinetic interaction between voriconazole and ciclosporin A following allogeneic bone marrow transplantation

Andreas H. Groll 1 *, Hedwig Kolve 1 , Karoline Ehlert 1 , Michael Paulussen 1 , and Josef Vormoor 1

1 Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children’s Hospital, Domagkstrasse 9a, 48129 Münster, Germany

* Corresponding author. E-mail: grollan{at}mednet.uni-muenster.de.

Received 6 October 2003 ; accepted 13 October 2003

Abstract

Voriconazole is a novel antifungal triazole that undergoes extensive oxidative metabolization involving several CYP450 isoenzymes. We report the case of a 14-year-old patient who received voriconazole concomitant with ciclosporin A as secondary antifungal prophylaxis after bone marrow transplantation. Temporary discontinuation of voriconazole due to worsening liver function tests (LFTs) resulted in a sudden drop of ciclosporin A trough levels in blood. Ciclosporin A trough levels returned to baseline following normalization of LFTs and re-institution of voriconazole. This report emphasizes the need for careful monitoring and dose adjustments of ciclosporin A in patients receiving concomitant voriconazole, and in whom voriconazole is discontinued in order to prevent subtherapeutic ciclosporin A levels with the potential consequence of graft-versus-host disease.

Keywords: antifungals, CYP450 isoenzymes, graft-versus-host disease
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