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The Annals of Pharmacotherapy: Vol. 27, No. 4, pp. 427-430.
© 1993 Harvey Whitney Books Company.
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Research Articles

Fluconazole-cyclosporine interaction: a dose-dependent effect?

JA Lopez-Gil

OBJECTIVE: To present cases supporting the hypothesis that fluconazole inhibition of cyclosporine metabolism is dose-dependent. DESIGN: Case reports. PATIENTS AND INTERVENTIONS: One renal-pancreatic transplant patient taking fluconazole 100 and 300 mg/d for 37 and 17 days, respectively; four bone marrow transplant recipients taking fluconazole 100 mg/d as antifungal prophylaxis and five other concurrent nonmatched recipients whose antifungal prophylactic agent is nystatin mouthwash. All of these patients underwent transplantation during the same period. RESULTS: There was a sharp rise in cyclosporine trough concentration (ng/mL), concentration:dose ratio (ng.mL-1/mg.kg-1), and serum creatinine concentration (mumol/L) in the renal-pancreatic transplantation patient taking fluconazole 300 mg/d. No such increase occurred at 100 mg/d. No significant alterations in cyclosporine concentration:dose ratio were seen in the patients undergoing bone marrow transplantation and receiving fluconazole 100 mg/d. CONCLUSIONS: The case of the renal-pancreatic transplantation patient shows a characteristic interaction profile, and it supports the hypothesis of a dose-dependent interaction between cyclosporine and fluconazole. Given the nephrotoxic potential of the immunosuppressant drug, dosage reduction and closer monitoring of cyclosporine concentrations and/or renal function in patients receiving fluconazole dosages greater than 200 mg/d must be considered.


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Copyright © 1993 by Harvey Whitney Books Company.