Vinca alkaloids: Voriconazole significantly increased plasma concentrations of the vinca alkaloids such as vinblastine, vincristine, and others as they dose should be tapered according to medical criteria.
-Alfusozina: Concomitant use of both drugs, causes an increase in the alfusozina pharmacological activity, being very important the control of cardiovascular parameters such as systemic blood pressure and pulse.
-Amprenavir: Voriconazole may inhibit the metabolism of amprenavir and vice versa amprenavir can alter the metabolism of voriconazole, as blood concentrations of both drugs may be increased and its toxic effects must be monitored if they are used in usual doses and concomitantly.
Oral-Anticoaulantes: Concomitant use of oral anticoagulants with voriconazole, causes a significant increase in prothrombin time, with a higher probability of risk of bleeding and should therefore adjust oral anticoagulant dose, when administered both drugs in the form joint.
-Atorvastatin: The concomitant use of voriconazole, leading to increased blood levels of atorvastatin and increases the occurrence of striated skeletal muscle CPK, myopathy and rhabdomyolysis. Monitor signs of myopathy and CPK levels, discontinuing the statin should appear suspected rhabdomyolysis.
-Barbiturates: they should not co-administered as a long-acting barbiturates, significantly decrease voriconazole concentrations, probably through induction of cytochrome P450 system.
""Benzodiazepines: Concomitant use of voriconazole and benzodiazepines metabolized by oxidation causes a significant increase in peak plasma concentrations of benzodiazepines as well as an increase in plasma half-life so that doses of benzodiazepines should be reduced to avoid toxicity. The likely mechanism for this interaction would be inhibition of cytochrome P450 3 A caused by this drug.
""Calcium channel blockers: Voriconazole may increase the plasma concentracones calcium channel blockers that are metabolized by cytochrome P450 3A4, so that doses of these drugs should be monitored to avoid toxicity.
""Carbamazepine: The concomitant use would be contraindicated because carbamazepine, significantly decreases voriconazole plasma concentrations probably by a mechanism mediated by cytochrome P450.
""Cyclosporin: When you use this drug in conjunction with voriconazole, the concentrations of cyclosporine may be increased, probably by inhibiting cytochrome P450-mediated voriconazole. Thus s cyclosporine plasma concentrations are increased and the dosage should be adjusted to half the usual to avoid toxicity, and control the plasma of cyclosporine Concentrates. After stopping voriconazole, evaluate the dose adjustment.
-Cisapride: When both drugs are administered together, the plasma concentration of cisapride is significantly increased by decreasing their metabolism, mediated by cytochrome P450. Adverse effects associated with increases in plasma cisapride, are usually the heart, such as extending the interval Q
-T and the emergence of several serious ventricular arrhythmias. They should not be coadministered.
-Ergot derivatives: Voriconazole can increase the plasma concentrations of ergot derivatives and lead to ergotism (nausea, vomiting, ischemia vsaoespástica). They should not be coadministered.
""Efavirenz: concurrent use may increase the concentrations of efavirenz and voriconazole reduce the interference in the metabolism of both drugs. They should not be coadministered.
""Phenytoin: Concomitant use of phenytoin with voriconazole, a decrease in plasma levels of voriconazole. The clinical management of this interaction is to monitor the efficacy of voriconazole and phenytoin concentrations, when administered concomitantly with voriconazole and adjust the dose of the antiepileptic.
""Lovastatin: The concomitant use of voriconazole, leading to increased blood levels of lovastatin and the appearance of increased creatine phosphokinase (CPK), myopathy and rhabdomyolysis. Monitor signs of myopathy and CPK levels, discontinuing the statin should appear suspected rhabdomyolysis.
-Nelfinavir: The metabolism of both drugs are mutually inhibited, so doses should be adjusted independently and according to the patient's clinical picture.
""Nevirapine: the use of both drugs can produce variations in plasma concentrations of both (increased concentrations of nevirapine and increase or decrease in voriconazole). Monitor the occurrence of toxicity by both drugs, as well as loss of efficacy of voriconazole and dose adjustment.
""Omeprazole: Omeprazole administration concomitantly with voriconazole, increases the plasma concentrations of the inhibitor of proton pump. It is recommended in case of using higher doses of omeprazole 40 mg, cut them in half.
""Pimozide: The metabolism of pimozide can be significantly inhibited by voriconazole, resulting in increased plasma concentrations of pimozide and toxic effects such as extending the interval Q
-T and serious ventricular arrhythmias. Do not be coadministered.
""Quinidine: Quinidine metabolism is inhibited when administered in conjunction with voriconazole, causing cardiovascular toxicity level, such as hypotension, prolonged PR interval, widening of QRS interval prolongation and Q
-T, with the appearance of ventricular arrhythmias torsion-edge type. They should not be coadministered.
""Rifampicin: Rifampicin when used in conjunction with voriconazole significantly reduced the Cmax and AUC of voriconazole with the efficiency loss, so that their use together is contraindicated.
-Ritonavir: the use of high doses of ritonavir (400 mg every 12 hours) decreases voriconazole plasma concentrations by induction of its metabolism by ritonavir, it is contraindicated the use of voriconazole and ritonavir at doses above. No data found the possibility of interaction with low dose ritonavir (100 mg every 12 hours).
-Saquinavir-may increase the plasma concentrations of both drugs by inhibiting their metabolism with an increased risk of toxicity. Monitor signs of toxicity for both drugs and adjust treatment.
""Simvastatin: The concomitant use of voriconazole, leading to increased blood levels of simvastatin and appearance of CPK increases in striated skeletal muscle, myopathy and rhabdomyolysis. Monitor signs of myopathy and creatine phosphokinase levels (CPK), discontinuing the statin should appear suspected rhabdomyolysis.
""Sirolimus: When using both drugs together, increase sirolimus concentrations by almost 75%, so that co-administration of both drugs should be avoided. The likely mechanism of interaction would be through inhibition of cytochrome P450.
-Sulfonylureas: Voriconazole increases the plasma concentrations of some sulphonylureas and therefore their use together can induce hypoglycemia. The management of this interaction would be the monitoring of blood glucose values and the likely mechanism involved in this interaction would be inhibition of cytochrome P450. Adjust the dose of hypoglycaemic.
Tacrolimus-: Co-administration of voriconazole and tacrolimus increase the serum concentrations of the latter drug, which might be related to the nephrotoxicity resulting from the interaction. The likely mechanism would be inhibition of cytochrome P450. It recommends reducing the dose of tacrolimus to third to start with voriconazole and monitor plasma levels of immunosuppression. After stopping this drug should be adjusted doses of tacrolimus
|Twice in a day||5||83.3%|
|4 times in a day||1||16.7%|
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Information checked by Dr. Sachin Kumar, MD Pharmacology