Pharmaceutical care of drug interaction between voriconazole and efavirenz
10.3760/cma.j.cn114015-20231129-00846
- VernacularTitle:依非韦伦与伏立康唑相互作用的药学监护
- Author:
Tingting CHEN
1
;
You LI
;
Qingquan ZHANG
;
Zhiqiang LIN
Author Information
1. 泉州市第一医院药剂科，泉州 362000
- Publication Type:Journal Article
- Keywords:
Drug interactions;
Voriconazole;
Efavirenz;
Therapeutic drug monitoring;
Dose adjustment;
Talaromyces marneffei
- From:
Adverse Drug Reactions Journal
2024;26(7):437-439
- CountryChina
- Language:Chinese
-
Abstract:
A 27-year-old female patient with AIDS received tenofovir alafenamide lamivudine and efavirenz(ART scheme). Because of the combined infection of talaromyces marneffei, she was given intravenous infusion of voriconazole 200 mg once per 12 hours. On the 4th day of medication, the valley blood concentration of voriconazole was 0.1 mg/L. The clinical pharmacist participated in the consultation and found that there was a drug interaction between efavirenz and voriconazole. The pharmacist recommended to discontinue efavirenz and switch to dolutegravir. After discontinuing efavirenz, the patient measured the blood trough concentration of voriconazole multiple times and adjusted the dose of voriconazole multiple times. Within 14 days of efavirenz discontinuation, the blood trough concentration of voriconazole changed slowly(0.1-0.4 mg/L), and after 14 days, the blood trough concentration remained basically stable. After increasing the dose of voriconazole to 300 mg once every 12 hours orally, the blood trough concentration of voriconazole increased to 1.8 mg/L, which was within the reference value range. This case suggests that when voriconazole is used in combination with efavirenz, even after discontinuing efavirenz, the metabolic induction effect of efavirenz still exists. Therefore, it is necessary to empirically increase the dose of voriconazole and dynamically adjust it based on therapeutic drug monitoring results.
