Drug-Drug Interaction Associated with Mold-Active Triazoles among Hospitalized Patients.
Antimicrob Agents Chemother. 2016 Mar 21;
Authors: Andes D, Azie N, Yang H, Harrington R, Kelley C, Tan RD, Wu EQ, Franks B, Kristy R, Lee E, Khandelwal N, Spalding J
Abstract
BACKGROUND: Triazoles remain the most commonly utilized antifungals. Recent developments have included the mold-active triazoles (MAT) itraconazole, voriconazole, and posaconazole, which are first-line agents for the treatment of filamentous fungal infections but have the potential for drug-drug interactions (DDI). This objective of this study was to evaluate the prevalence of triazole DDI.
METHODS: Hospitalized US adults with MAT use were identified in the Cerner HealthFacts database which contained data from over 150 hospitals (2005-2013). DDIs of MAT were categorized using drug labels and DRUGDEX® (Thompson Micromedex) into 4 groups (contraindicated; major; moderate; minor). Minor DDIs were not counted. A DDI event was considered to have occurred if two conditions were met: 1) used at least one drug with at least a moderate interaction classification with the MAT during the hospitalization and 2) there was at least a 1-day administration overlap between the MAT and the interacting drug.
RESULTS: 6962 hospitalizations were identified with MAT use. Among them, 88% of voriconazole, 86% of itraconazole, and 93% of posaconazole hospitalizations included a concomitant interacting drug. 68% of posaconazole, 34% of itraconazole, and 20% of voriconazole hospitalizations had at least one contraindicated DDI. 83% of posaconazole, 61% of itraconazole, and 82% of voriconazole hospitalizations had at least one severe DDI.
CONCLUSION: The findings of this study demonstrate that a majority of hospitalized patients receiving MAT were at risk for severe drug-drug interactions and highlight the need for antifungal stewardship.
PMID: 27001815 [PubMed - as supplied by publisher]