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Frequency of potential azole drug–drug interactions and consequences of potential fluconazole drug interactions
Author(s) -
Yu D. Tony,
Peterson Josh F.,
Seger Diane L.,
Gerth William C.,
Bates David W.
Publication year - 2005
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.1073
Subject(s) - fluconazole , azole , medicine , drug , drug interaction , ketoconazole , itraconazole , pharmacology , antifungal , dermatology
Purpose To assess the frequency of potential azole–drug interactions and consequences of interactions between fluconazole and other drugs in routine inpatient care. Methods We performed a retrospective cohort study of hospitalized patients treated for systemic fungal infections with an oral or intravenous azole medication between July 1997 and June 2001 in a tertiary care hospital. We recorded the concomitant use of medications known to interact with azole antifungals and measured the frequency of potential azole drug interactions, which we considered to be present when both drugs were given together. We then performed a chart review on a random sample of admissions in which patients were exposed to a potential moderate or major drug interaction with fluconazole. The list of azole‐interacting medications and the severity of interaction were derived from the DRUGDEX® System and Drug Interaction Facts. Results Among the 4185 admissions in which azole agents (fluconazole, itraconazole or ketoconazole) were given, 2941 (70.3%) admissions experienced potential azole–drug interactions, which included 2716 (92.3%) admissions experiencing potential fluconazole interactions. The most frequent interactions with potential moderate to major severity were co‐administration of fluconazole with prednisone (25.3%), midazolam (17.5%), warfarin (14.7%), methylprednisolone (14.1%), cyclosporine (10.7%) and nifedipine (10.1%). Charts were reviewed for 199 admissions in which patients were exposed to potential fluconazole drug interactions. While four adverse drug events (ADEs) caused by fluconazole were found, none was felt to be caused by a drug–drug interaction (DDI), although in one instance fluconazole may have contributed. Conclusions Potential fluconazole drug interactions were very frequent among hospitalized patients on systemic azole antifungal therapy, but they had few apparent clinical consequences. Copyright © 2005 John Wiley & Sons, Ltd.