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J Mycol Med. 2017 Dec;27(4):539-542. doi: 10.1016/j.mycmed.2017.08.001. Epub 2017 Sep 1.

Risk factors for suboptimal drug concentration of posaconazole oral suspension in patients with hematologic malignancy.

Author information

1
Department of internal medicine, Seoul national university college of medicine, 101, Daehag-ro, 03080 Jongno-gu, Seoul, Republic of Korea.
2
Department of clinical pharmacology and therapeutics, Seoul national university college of medicine, Seoul, Republic of Korea.
3
Department of laboratory medicine, Seoul national university college of medicine, Seoul, Republic of Korea.
4
Department of internal medicine, Seoul national university college of medicine, 101, Daehag-ro, 03080 Jongno-gu, Seoul, Republic of Korea. Electronic address: ihkimmd@snu.ac.kr.
5
Department of internal medicine, Seoul national university college of medicine, 101, Daehag-ro, 03080 Jongno-gu, Seoul, Republic of Korea. Electronic address: wbpark1@snu.ac.kr.

Abstract

Absorption of posaconazole oral suspension is influenced by several factors including diet, medications, and mucosal integrity. However, there are few prospective data about which is the most important modifiable factor in routine clinical practice. We prospectively analyzed clinical risk factors associated with low posaconazole trough concentrations in 114 patients receiving anticancer chemotherapy due to acute myeloid leukemia or myelodysplastic syndrome who received posaconazole oral suspension. In multivariate analyses, risk factors for drug level<500ng/mL included low calorie intake, mucositis≥grade 2, H2 blocker famotidine and proton-pump inhibitor. The only significant risk factor for drug level<700ng/mL was famotidine use (adjusted relative risk, 3.18; 95% confidence interval, 1.07-9.11; P=0.038). In conclusion, medication of H2 blocker famotidine should be cautious in patients with hematologic malignancy receiving posaconazole suspension.

KEYWORDS:

Famotidine; H(2) blocker; PPI; Posaconazole

PMID:
28867258
DOI:
10.1016/j.mycmed.2017.08.001
[Indexed for MEDLINE]

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