Drug interactions amphotericin

Itraconazole and ketoconazole (200-800 mg/day orally for 1 year) are effective in 74% to 86% of cases, but relapses are common fluconazole 200-400 mg daily is less effective (64%) than ketoconazole or itraconazole, and relapses are seen in 29% of responders Severe disease Amphotericin B 0.7 mg/kg/day for a minimum total dose of 35 mj kg is effective in 59% to 100% of cases and should be used in patients who require hospitalization or are unable to take itraconazole because of drug interactions, allergies, failure to absorb drug or failure to improve clinically after a minimum of 12 weeks of itiaconazole therapy... 

Drug Interactions Zidovudine Probenecid Imipenem-cilastatin Dapsone Pentamidine Flucytosine Vincristine Vinblastine Adriamycin Amphotericin B TMP-SMX Other nucleoside analogues... 

Drug interactions Amphotericin B or potassium-wasting diuretics may contribute to digoxin toxicity ACE-I, amiodarone, bepridii, diltiazem.guinidine, and verapamil may increase digoxin levels. 

Hope and coworkers [91], in studying combination therapy of antifungal drugs in the treatment of invasive candidiasis, assessed pharmacodynamic interactions of amphotericin B deoxycholate and 5-fluorocytosine. The interaction model they used was based on the Greco model of drug interaction [92] represented by the equation... 

Topical therapy with clotrimazole or nystatin for 7 days is usually adequate for treating mucocutaneous candidiasis in most solid-organ transplant patients. Use of topical therapy will reduce the number of systemic drugs that these patients receive and hence minimize the risk of drug-drug interactions. Failure to respond to topical agents warrants the use of fluconazole. Low-dose amphotericin B 5-10 mg daily for 7 to 10 days is reserved for the unusual cases of treatment failure. 

In more advanced esophageal disease, oral azoles may be ineffective. Until recently, intravenous amphotericin B deoxycholate has been the alternative for patients with endoscopically proven disease who have failed fluconazole or itraconazole therapy.22 2" Moderate disease may be treated adequately with low- to moderate-dose amphotericin B for 10 days, although higher doses may be necessary for patients with AIDS or advanced disease. " Voriconzole, a new triazole antifungal available in both oral and intravenous preparations, produces comparable clinical response to fluconazole. Voriconazole has been associated with more side effects and multiple pharmacokinetic drug interactions. " ... 

Drug-drug interactions A 71-year-old woman taking 400 mg per day miconazole oral gel four times daily was admitted to hospital because of massive proteinuria (10 g per day) and systemic oedema [20 ]. She received oral prednisolone, cyclosporine (150 mg per day) and was also treated with warfarin (2-2.5 mg per day). Increased oral bioavailability of warfarin and cyclosporine were suggested her INR had increased to 7.25 and cyclosporine trough concentration had increased from 132.9 to 1296.5 ng/ml. Also, a significant miconazole plasma concentration (0.35 ng/ml) was measured. Miconazole was discontinued, amphotericin B was started and cyclosporine A dose was adjusted to 125 mg per day. 

Other drugs that may interact with cardiac glycosides include the following Albuterol, amphotericin B, beta-blockers, calcium, disopyramide, loop diuretics, nondepolarizing muscle relaxants, potassium-sparing diuretics, succinylcholine, sympathomimetics, thiazide diuretics, thioamines, and thyroid hormones. 

Drugs that may interact with miconazole include amphotericin B, astemizole, cisapride, oral anticoagulants, phenytoin, and terfenadine. 

Drugs that may interact with foscarnet include nephrotoxic drugs (eg, aminoglycosides, amphotericin B, IV pentamidine), pentamidine, and zidovudine. Foscarnet decreases serum levels of ionized calcium. Exercise particular caution when other drugs known to influence serum calcium levels are used concurrently. 

Drugs that may interact with zalcitabine include antacids, chloramphenicol, cisplatin, dapsone, didanosine, disulfiram, ethionamide, glutethimide, gold, hydralazine, iodoquinol, isoniazid, metronidazole, nitrofurantoin, phenytoin, ribavirin, vincristine, cimetidine, metoclopramide, amphotericin, aminoglycosides, foscarnet, antiretroviral nucleoside analogs, pentamidine, and probenecid. 

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