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Drug interaction between voriconazole and tacrolimus in allogeneic hematopoietic SCT recipients

Bone Marrow Transplantation volume 46, pages 450–451 (2011)Cite this article

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We read with interest the recent article in which Trifilio et al.1 reported the results of preemptive dose modification and therapeutic drug monitoring of tacrolimus in recipients of allogeneic hematopoietic SCT receiving both tacrolimus and voriconazole. They showed that their preemptive dose modification succeeded in maintaining the blood concentration of tacrolimus in spite of the significant drug interaction between tacrolimus and voriconazole. Although we partly agree with their results and opinions, we would like to make several comments.

Our previous report,2 which was cited in theirs, showed that voriconazole administration significantly increased the blood concentration of calcineurin inhibitors such as tacrolimus and CsA with significant interindividual variability. We used a concentration/dose (C/D) ratio ((ng/mL)/(mg/kg)) for the quantitative evaluation of the drug interaction, and the median increase in the C/D ratio of tacrolimus after voriconazole administration was 115.6%, with a range of 25.4−307.6%. Thus, we concluded that dose adjustment of calcineurin inhibitors (tacrolimus and CsA) should be made on an individual basis, although the manufacturer's recommendation sets uniform dose-reduction rates (1/3 of the original dose for tacrolimus, 1/2 for CsA).3

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References

  1. Trifilio SM, Scheetz MH, Pi J, Mehta J . Tacrolimus use in adult allogeneic stem cell transplant recipients receiving voriconazole: preemptive dose modification and therapeutic drug monitoring. Bone Marrow Transplant (e-pub ahead of print 7 December 2009; doi:10.1038/bmt.2009.345).

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  2. Mori T, Aisa Y, Kato J, Nakamura Y, Ikeda Y, Okamoto S . Drug interaction between voriconazole and calcineurin inhibitors in allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2009; 44: 371–374.

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  3. Vfend (Voriconazole) Package Insert. Pfizer Inc., New York, NY, 2004.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Mori, J Kato, A Yamane, Y Ono, T Shimizu & S Okamoto

  2. Novartis Pharma Program for the Clinical Therapeutics of Hematologic Malignancies, Keio University School of Medicine, Tokyo, Japan

    J Kato & A Yamane

Authors
  1. T Mori
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  2. J Kato
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  3. A Yamane
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  4. Y Ono
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  5. T Shimizu
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  6. S Okamoto
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Corresponding author

Correspondence to T Mori.

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The authors declare no conflict of interest.

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Mori, T., Kato, J., Yamane, A. et al. Drug interaction between voriconazole and tacrolimus in allogeneic hematopoietic SCT recipients. Bone Marrow Transplant 46, 450–451 (2011). https://doi.org/10.1038/bmt.2010.105

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