Voriconazole Vincristine

Clinically important, potentially hazardous interactions with abacavir, atorvastatin, bepridil, bupropion, carbamazepine, clarithromycin, cyclosporine, dexamethasone, digoxin, felodipine, fluticasone propionate, fosamprenavir, itraconazole, ketoconazole, lovastatin, methadone, midazolam, nicardipine, nifedipine, phenobarbital, phenytoin, rifabutin, simvastatin, sirolimus, St John s wort, systemic lidocaine, tacrolimus, tenofovir, trazodone, vinblastine, vincristine, voriconazole, warfarin, zidovudine... 

FLUCONAZOLE, ITRACONAZOLE, KETOCONAZOLE, VORICONAZOLE (POSSIBLY POSACONAZOLE) VINCA ALKALOIDS -VINBLASTINE, VINCRISTINE, VINORELBINE t adverse effects of vinblastine and vincristine Inhibition of CYP3A4-mediated metabolism. Also inhibition of P-gp efflux of vinblastine Monitor FBCs and watch for early features of toxicity (pain, numbness, tingling in the fingers and toes, jaw pain, abdominal pain, constipation, ileus). Consider selecting an alternative drug... 

The manufacturers of voriconazole advise caution if it is given to patients treated with the vinca alkaloids (vincristine and vinblastine are named) because of the risk of neurotoxicity.The US manufacturer recommends that dose adjustments of the vinca alkaloids should be considered. ... 

Vincristine Vincristine-associated neurotoxicity has been reported in association with posacormzole co-administration in a 9-year-old girl with acute lymphoblastic leukemia [51 ]. Six days after the last dose of vincristine, she reported symptoms of severe peripheral neuropathy, abdominal cramps, and constipation she then developed fluctuating impairment of consciousness and seizures. There was complete resolution within 7 days after withdrawal of posacona-zole. Vincristine-related neuropathy was also exacerbated by voriconazole in a patient with previously undiagnosed, X-linked Charcot-Marie-Tooth disease [52 ]. 

These symptoms occurred in 50%, 75%, and 67% of those who took fluconazole, voriconazole, and posaconazole respectively. The course of vincristine was more EuD likely to take be incomplete when patients took an azole (48% versus 9.5%). 

Porter CC, Carver AE, Albano EA. Vincristine induced peripheral neuropathy potentiated by voriconazole in a patient with previously undiagnosed CMTIX. Pediatr Blood Cancer 2009 52 298-300. 

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