Cyclosporine and Itraconazole Interaction in Heart and Lung Transplant Recipients
Authors: Mordechai R. Kramer, Sara E. Marshall, David W. Denning, Anne M. Keogh, Richard M. Tucker, John N. Galgiani, Norman J. Lewiston, David A. Stevens, James Theodore
Journal: Annals of Internal Medicine (1990)

Brief Reports15 August 1990Cyclosporine and Itraconazole Interaction in Heart and Lung Transplant RecipientsMordechai R. Kramer, MD, Sara E. Marshall, MBBCh, David W. Denning, MBBS, Anne M. Keogh, MBBS, Richard M. Tucker, MD, John N. Galgiani, MD, Norman J. Lewiston, MD, David A. Stevens, MD, James Theodore, MDMordechai R. Kramer, MD, Sara E. Marshall, MBBCh, David W. Denning, MBBS, Anne M. Keogh, MBBS, Richard M. Tucker, MD, John N. Galgiani, MD, Norman J. Lewiston, MD, David A. Stevens, MD, James Theodore, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-4-327 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptItraconazole is a new triazole antifungal (1-3). The infrequency of serious toxicity makes it particularly appropriate in patients receiving cyclosporine therapy, in whom nephrotoxicity is common. A related drug, ketoconazole, interacts significantly with cyclosporine (4). However, no interaction has been clearly documented between itraconazole and cyclosporine. We recently treated seven patients with itraconazole for serious fungal infections after heart-lung, heart, or lung transplantation. We observed an interaction between itraconazole and cyclosporine with subsequent impairment of patient renal function.Case ReportsFour heart-lung, two heart, and one lung transplant recipients were treated with itraconazole (Janssen Pharmaceutica, Beerse, Belgium) for aspergillosis (five...References1. Denning D, Tucker R, Hanson L, and Stevens D. Treatment of invasive aspergillosis with itraconazole. Am J Med. 1989;86:791-800. CrossrefMedlineGoogle Scholar2. Tucker R, Williams P, Arathoon E, and Stevens D. Treatment of mycoses with itraconazole. Ann NY Acad Sci. 1988;544:451-70. CrossrefMedlineGoogle Scholar3. Dupont B and Drouhet E. Early experience with itraconazole in vitro and in patients: pharmacokinetic studies and clinical results. Rev Infect Dis. 1987;9:S71-6. CrossrefMedlineGoogle Scholar4. Ferguson R, Sutherland D, Simmons R, and Najarian J. Ketoconazole, cyclosporine metabolism, and renal transplantation [Letter]. Lancet. 1982;1:882-3. CrossrefGoogle Scholar5. Cockburn I and Krupp P. An appraisal of drug interaction with Sandimmun. Transplant Proc. 1989;21:3845-50. MedlineGoogle Scholar6. Whiting P, Thomson A, and Simpson J. Cyclosporine: toxicity, metabolism, and drug interactions—implication from animal studies. Transplant Proc. 1985;17(Suppl):134-44. MedlineGoogle Scholar7. Lavrijsen K, van Houdt J, Thijs D, Meuldermans W, and Heykants J. Interaction of miconazole, ketoconazole and itraconazole with rat-liver microsomes. Xenobiotica. 1987;17:45-57. CrossrefMedlineGoogle Scholar8. Damanhouri Z, Gumbleton M, Nicholls P, and Shaw M. In-vivo effects of itraconazole on hepatic mixed-function oxidase. J Antimicrob Chemother. 1988;21:187-94. CrossrefMedlineGoogle Scholar9. Shaw M, Gumbelton M, and Nicholls P. Interaction of cyclosporine and itraconazole [Letter]. Lancet. 1987;1:637. Google Scholar10. Kwan J, Foxall P, Davidson D, Bending M, and Eisinger A. Interaction of cyclosporine and itraconazole [Letter]. Lancet. 1987;1: 282. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Mordechai R. Kramer, MD; Sara E. Marshall, MBBCh; David W. Denning, MBBS; Anne M. Keogh, MBBS; Richard M. Tucker, MD; John N. Galgiani, MD; Norman J. Lewiston, MD; David A. Stevens, MD; James Theodore, MDFrom Stanford University Medical Center, Stanford, California; Santa Clara Valley Medical Center, San Jose, California; the Mycoses Study Group, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and the University of Arizona College of Medicine, Tucson, Arizona. For current author addresses, see end of text. 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