Cyclosporine and itraconazole interaction in heart and lung transplant recipients

Article Abstract:

Patients receiving heart-lung, heart, or lung transplants frequently "reject" the transplanted tissue because their immune system perceives it as a foreign substance. Drugs that prevent such a rejection (immunosuppressants) are frequently used to inhibit this reaction. Cyclosporine is a common, effective immunosuppressant, but a serious side effect of its use is the development of potentially fatal fungal infections. Drugs that kill fungi (antifungals) may be used, but serious kidney toxicity often results when antifungals are given to transplant patients receiving cyclosporine. A new antifungal drug called itraconazole is associated with a low kidney toxicity; its safety and effectiveness in seven transplant patients receiving cyclosporine was studied. Within 24 to 48 hours after itraconazole therapy was started, cyclosporine levels rose in the blood and kidney toxicity ensued. Itraconazole may inhibit the liver's degradation of cyclosporine resulting in elevated blood levels of cyclosporine. Despite the immediate adjustment of the cyclosporine dose, toxic levels of cyclosporine were observed in most patients in the first 7 to 14 days of itraconazole therapy. It is suggested that the cyclosporine dose be reduced by 50 percent when itraconazole therapy is started, and that cyclosporine levels be monitored frequently. Such monitoring should prevent kidney toxicity in transplant patients receiving cyclosporine and itraconazole. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Usage, Lungs, Heart, Graft rejection, Heart transplantation, Cyclosporine, Cyclosporins, Transplantation immunology, Lung transplantation

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Itraconazole therapy for chronic coccidioidal meningitis

Article Abstract:

Coccidioidomycosis is an infection caused by the fungus Coccidioidis immitis, and is common in the southwest United States and parts of Central and South America. The disease commonly affects the lungs, bones, and skin, and 16 percent of patients develop meningitis, inflammation of membranes in the spinal cord and brain. The antibiotic amphotericin B can reduce the number of deaths due to coccidioidal meningitis to 30 percent, but it may also produce toxic effects upon the nerves. The drug itraconazole was shown to be effective in eliminating various fungi, including C. immitis. The effectiveness of itraconazole in treating coccidioidal meningitis was assessed in eight patients over a 10-month period. Coccidioidal meningitis was treated in four of five patients receiving itraconazole and three patients receiving amphotericin B. One patient had mild nausea related to drug therapy. The findings of this small study show that itraconazole is effective in treating coccidioidal meningitis that is unresponsive to more common antifungal agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Causes of, Complications and side effects, Itraconazole, Coccidioidomycosis

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Is it ever safe to stop azole therapy for Coccidioides immitis meningitis?

Article Abstract:

It appears that life-long azole treatment may be necessary for patients infected with Coccidioides immitis meningitis. Researchers evaluated the long-term effects of discontinuing azole treatment in 18 patients with coccidioidal meningitis who stopped therapy either after a doctor's recommendation or, in the absence of symptoms, the patient considered the infection cured. The infection returned in 78% of these patients between .5 months and 30 months after discontinuing treatment. Three of the 4 patients taking ketoconazole experienced a relapse more than a year after stopping therapy. All of the 6 patients taking fluconazole experienced a relapse within 7 months after discontinuing treatment. Three of the 18 patients died. There was an association between two of these deaths and complications following relapse.

Coccidioides immitis, Ascomycota

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