Archive \ Volume.15 2024 Issue 2

Drug-Drug Interaction Between Fluconazole and Vancomycin: A Case Report

, ,
  1. Departament of Pharmacy, University clinical hospital “Lozano Blesa”, Zaragoza.
  2. Unit for the Rational Use of Medicines, Aragon Health Service, Zaragoza, Spain.

Abstract

We present the case of a probable pharmacokinetic drug-drug interaction (DDI) between fluconazole (FLU) and vancomycin (VCM), in a patient who underwent hepatobiliary surgery, and biliary drainage, and was under treatment with vancomycin, meropenem, and fluconazole, due to infectious pathology. Changes in the kinetic process of VCM and FLU has not been fully elucidated. Therefore, understanding the changes in renal transporters involved in the renal excretion pathway of VCM and FLU (e.g. multidrug resistance-associated proteins, organic cation transporters, P-glycoprotein) is beneficial in predicting better drug disposition and optimize optimizing dosing. Inhibition of the aforementioned transporters is a common mechanism underlying DDIs. After pharmacokinetic monitoring of VCM treatment, the trough concentration values and the half-life of VCM showed an abnormally unexpected increase when VCM was used in combination with FLU, compared to data obtained when vancomycin was used without fluconazole. Said changes, of the pharmacokinetic parameters studied, would support a DDI between FLU and VCM. Because of this, special caution is required whenever VCM is co-administered with fluconazole, and close monitoring of VCM trough concentrations is recommended to minimize the risk of toxicity.


Downloads: 339
Views: 1464

How to cite:
Vancouver
Lozano R, Bona C, Fresquet R. Drug-Drug Interaction Between Fluconazole and Vancomycin: A Case Report. Arch Pharm Pract. 2024;15(2):1-3. https://doi.org/10.51847/4AJLrv27ak
APA
Lozano, R., Bona, C., & Fresquet, R. (2024). Drug-Drug Interaction Between Fluconazole and Vancomycin: A Case Report. Archives of Pharmacy Practice, 15(2), 1-3. https://doi.org/10.51847/4AJLrv27ak

Download Citation
References
  1. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011;52(3):285-92.
  2. Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, Gaynes R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992–2003. Clin Infect Dis. 2006;42(3):389-91.
  3. Technical sheet vancomycin Pfizer 500 mg powder for concentrate for solution for infusion EFG. Available from: https://cima.aemps.es/cima/dochtml/ft/73784/FT_73784.html
  4. Horn JR, Hansten PD, Chan LN. Proposal for a new tool to evaluate drug interaction cases. Ann Pharmacother. 2007;41(4):674-80.
  5. Fanos V, Cataldi L. Renal transport of antibiotics and nephrotoxicity: A review. J Chemother. 2001;13(5):461-72.
  6. Pea F, Furlanut M. Pharmacokinetic aspects of treating infections in the intensive care unit: Focus on drug interactions. Clin Pharmacokinet. 2001;40(11):833-68.
  7. Wang W, Zheng N, Zhang J, Huang X, Yu S. Effect of efflux transporter inhibition on the distribution of fluconazole in the rat brain. Neurochem Res. 2017;42(8):2274-81.
  8. Guo X, Meng Q, Liu Q, Wang C, Sun H, Peng J, et al. JBP485 improves gentamicin-induced acute renal failure by regulating the expression and function of Oat1 and Oat3 in rats. Toxicol Appl Pharmacol. 2013;271(2):285-95.
  9. Liu T, Meng Q, Wang C, Liu Q, Guo X, Sun H, et al. Changes in expression of renal Oat1, Oat3, and Mrp2 in cisplatin-induced acute renal failure after treatment of JBP485 in rats. Toxicol Appl Pharmacol. 2012;264 (3):423-30.
  10. Fransson M, Helldén A, Östholm Balkhed Å, Nezirević Dernroth D, Ha M, Haglund M, et al. Case report: Subtherapeutic vancomycin and meropenem concentrations due to augmented renal clearance in a patient with intracranial infection caused by streptococcus intermedius. Front Pharmacol. 2021;12:728075.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.