Drug-drug interaction: decreased posaconazole trough concentrations during concomitant flucloxacillin treatment.

Posaconazole is used as prophylaxis of invasive fungal disease in immune-compromised haematological patients with prolonged neutropenia after intensive chemotherapy. During routine therapeutic drug monitoring of posaconazole, we repeatedly observed low posaconazole serum concentrations in patients that were concomitantly treated with flucloxacillin. A possible interaction between flucloxacillin and posaconazole was explored in this case series. Posaconazole trough serum concentrations during and before/after flucloxacillin treatment were collected from 10 patients. With a median concentration of 0.5 mg/L (IQR 0.3-0.6), the posaconazole trough serum concentration decreased by 47% during flucloxacillin treatment compared with the concentration before/after flucloxacillin treatment (0.9 mg/L, IQR 0.6-1.3). As a result, the posaconazole target trough concentration of ≥0.7 mg/L was only achieved in five out of nine patients during flucloxacillin treatment. Careful monitoring of posaconazole serum trough concentrations is recommended when concomitant use of flucloxacillin cannot be avoided. © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Citation

Julia M Wortman, Emiel Leegwater, Daniëlle Van Lammeren-Venema, Cees Van Nieuwkoop, Annemieke Sobels, Erik B Wilms. Drug-drug interaction: decreased posaconazole trough concentrations during concomitant flucloxacillin treatment. The Journal of antimicrobial chemotherapy. 2023 Jun 01;78(6):1471-1475

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PMID: 37039028

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