Can you take Actos with Voriconazole?

The pioglitazone in Actos has a minor potential interaction with Anemia.

Thiazolidinediones can cause slight decreases in hemoglobin and hematocrit. In clinical studies, hemoglobin levels were reduced primarily within the first 4 to 12 weeks of therapy but remained relatively constant thereafter. These changes may be related to increased plasma volume and have rarely been associated with any significant hematologic clinical effects. Nevertheless, caution may be advisable when thiazolidinediones are prescribed to patients with certain anemias.

Voriconazole has a moderate potential interaction with Arrhythmia.

Some azole antifungals have been associated with prolongation of the QT interval on the ECG. Rare cases of QT prolongation and torsade de pointes have been reported during postmarketing experience; such reports usually involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions, such as congenital/acquired QT prolongation, cardiomyopathy (especially when heart failure is present), sinus bradycardia, and existing symptomatic arrhythmias. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

The pioglitazone in Actos has a moderate potential interaction with Bladder Cancer.

There are insufficient data to determine if pioglitazone has an effect on preexisting bladder tumors or if it can cause bladder cancer. However, the manufacturer does not recommend the use of pioglitazone in patients with active bladder cancer. In patients with history of bladder cancer the benefit of treatment versus the risk of cancer recurrence during treatment should be considered.

Voriconazole has a moderate potential interaction with Bone Marrow Transplantation.

Patients with risk factors for acute pancreatitis (e.g., recent chemotherapy, hematopoietic stem cell transplantation) should be monitored for the development of pancreatitis during voriconazole therapy.

Voriconazole has a moderate potential interaction with Cardiomyopathy.

Some azole antifungals have been associated with prolongation of the QT interval on the ECG. Rare cases of QT prolongation and torsade de pointes have been reported during postmarketing experience; such reports usually involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions, such as congenital/acquired QT prolongation, cardiomyopathy (especially when heart failure is present), sinus bradycardia, and existing symptomatic arrhythmias. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

The pioglitazone in Actos has a major potential interaction with Diabetes, Type 1.

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

The pioglitazone in Actos has a moderate potential interaction with Diabetes Mellitus.

New onset or worsening diabetic macular edema with decreased visual acuity have been reported in postmarketing reports in some diabetic patients who were taking thiazolidinedione drugs. Some patients presented with blurred vision or decreased visual acuity, but some patients appear to have been diagnosed on routine ophthalmologic examination. Most patients had peripheral edema at the time macular edema was diagnosed. Some patients had improvement in their macular edema after discontinuation of their thiazolidinedione. Patients with diabetes should have regular eye exams by an ophthalmologist according to current standards of care. Additionally, any diabetic who reports any kind of visual symptom should be promptly referred to an ophthalmologist, regardless of the patient's underlying medications or other physical findings.

The pioglitazone in Actos has a major potential interaction with Diabetic Ketoacidosis.

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

The pioglitazone in Actos has a moderate potential interaction with Diabetic Macular Edema.

New onset or worsening diabetic macular edema with decreased visual acuity have been reported in postmarketing reports in some diabetic patients who were taking thiazolidinedione drugs. Some patients presented with blurred vision or decreased visual acuity, but some patients appear to have been diagnosed on routine ophthalmologic examination. Most patients had peripheral edema at the time macular edema was diagnosed. Some patients had improvement in their macular edema after discontinuation of their thiazolidinedione. Patients with diabetes should have regular eye exams by an ophthalmologist according to current standards of care. Additionally, any diabetic who reports any kind of visual symptom should be promptly referred to an ophthalmologist, regardless of the patient's underlying medications or other physical findings.

Voriconazole has a moderate potential interaction with Electrolyte Abnormalities.

Electrolyte disturbances (such as hypokalemia, hypomagnesemia, and hypocalcemia) should be monitored and corrected before and during voriconazole therapy.

The pioglitazone in Actos has a moderate potential interaction with Fluid Retention.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Voriconazole has a moderate potential interaction with Galactosemia.

Voriconazole tablets contain lactose and should not be given to patients with galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption. Voriconazole oral suspension contains sucrose.

The pioglitazone in Actos has a major potential interaction with Heart Failure.

The use of thiazolidinediones, alone or in combination with other antidiabetic agents, has been associated with fluid retention and new onset or exacerbation of heart failure. An increased risk of cardiovascular events (heart failure worsening; new or worsening edema; new or worsening dyspnea; increases in heart failure medication; myocardial infarction; angina; cardiovascular hospitalization and deaths) has been reported with rosiglitazone therapy in type II diabetic patients with New York Heart Association (NYHA) Class I or II congestive heart failure compared to placebo. Likewise, overnight hospitalization for CHF was observed in 9.9% of diabetic patients with NYHA Class II and III heart failure on pioglitazone compared to 4.7% of patients on glyburide. An increased incidence of cardiovascular adverse events including edema and cardiac failure has also been reported in patients receiving a thiazolidinedione in combination with insulin relative to insulin and placebo. Therapy with thiazolidinediones should be administered cautiously and initiated at the lowest recommended dosage in patients with congestive heart failure. Thiazolidinediones are contraindicated for the treatment of patients with NYHA Class III or IV cardiac status. Patients should be monitored for signs of worsening heart failure such as increased dyspnea, edema, and weight gain. Therapy should be discontinued if any deterioration in cardiac status occurs.

The pioglitazone in Actos has a moderate potential interaction with High Blood Pressure.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Voriconazole has a moderate potential interaction with Lactose Intolerance.

Voriconazole tablets contain lactose and should not be given to patients with galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption. Voriconazole oral suspension contains sucrose.

The pioglitazone in Actos has a moderate potential interaction with Liver Disease.

Initiation of rosiglitazone or pioglitazone therapy is not recommended in patients who exhibit clinical evidence of active liver disease or increased baseline serum transaminase levels (ALT exceeding 2.5 times upper limit of normal). Use of these agents is also not recommended in patients who have experienced jaundice during treatment with troglitazone. The use of troglitazone, another agent in the thiazolidinedione class, has been associated with clinically significant elevations in liver enzymes, reversible jaundice, and idiosyncratic hepatocellular injury including rare cases of liver failure, liver transplants, and death. Injury has occurred after both short- and long-term treatment. While these effects have not been associated with other thiazolidinediones in clinical trials, concerns exist because of their structural similarities. In addition, isolated cases of hepatitis and hepatic enzyme elevations to 3 or more times the upper limit of normal have been reported with both rosiglitazone and pioglitazone during postmarketing use. Rarely, these events have involved hepatic failure with and without fatal outcome, although causality has not been established. Until more safety data are available, patients who are prescribed thiazolidinedione therapy should have serum transaminase levels checked at baseline and periodically thereafter as clinically necessary. Mild to moderate elevations (ALT less than or equal to 2.5 times ULN) require cautious use with more frequent monitoring to determine if the elevations resolve or worsen. Patients who develop potential symptoms of hepatic injury such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, and dark urine should have liver enzymes checked. Therapy should be withdrawn if ALT is elevated and persists above 3 times ULN or if jaundice develops.

Voriconazole has a moderate potential interaction with Liver Disease.

Serious hepatic reactions (including clinical hepatitis, cholestasis, fulminant hepatic failure [including fatalities]) have been reported infrequently during voriconazole therapy. Hepatic reactions have primarily occurred in patients with serious underlying medical conditions (mainly hematological malignancy). Serum transaminase levels and bilirubin should be measured at the start of and during voriconazole therapy, according to the manufacturer product information.

Voriconazole is primarily metabolized by the liver and has been shown to accumulate significantly in patients with impaired hepatic function. Adult patients with baseline liver function tests (ALT, AST) of up to 5 times the upper limit of normal do not require dose adjustments; however, liver function tests should continue to be monitored for further elevations. The manufacturer recommends that the maintenance dose be halved in adult patients with mild to moderate liver dysfunction/cirrhosis (Child-Pugh A and B). Voriconazole has not been studied in adult patients with severe liver dysfunction/cirrhosis (Child-Pugh C) or in patients with chronic hepatitis B or C; no dosing recommendations are available for patients with severe liver dysfunction. Voriconazole should only be used in patients with severe liver dysfunction if the benefit outweighs the potential risk. Patients with liver dysfunction must be carefully monitored for drug toxicity. Dosage adjustment has not been established in pediatric patients with liver dysfunction.

Voriconazole has a moderate potential interaction with Myeloproliferative Disorders.

Serious hepatic reactions (including clinical hepatitis, cholestasis, fulminant hepatic failure [including fatalities]) have been reported infrequently during voriconazole therapy. Hepatic reactions have primarily occurred in patients with serious underlying medical conditions (mainly hematological malignancy). Serum transaminase levels and bilirubin should be measured at the start of and during voriconazole therapy, according to the manufacturer product information.

Voriconazole is primarily metabolized by the liver and has been shown to accumulate significantly in patients with impaired hepatic function. Adult patients with baseline liver function tests (ALT, AST) of up to 5 times the upper limit of normal do not require dose adjustments; however, liver function tests should continue to be monitored for further elevations. The manufacturer recommends that the maintenance dose be halved in adult patients with mild to moderate liver dysfunction/cirrhosis (Child-Pugh A and B). Voriconazole has not been studied in adult patients with severe liver dysfunction/cirrhosis (Child-Pugh C) or in patients with chronic hepatitis B or C; no dosing recommendations are available for patients with severe liver dysfunction. Voriconazole should only be used in patients with severe liver dysfunction if the benefit outweighs the potential risk. Patients with liver dysfunction must be carefully monitored for drug toxicity. Dosage adjustment has not been established in pediatric patients with liver dysfunction.

The pioglitazone in Actos has a moderate potential interaction with Pleural Effusion.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

The pioglitazone in Actos has a moderate potential interaction with Premenopausal Anovulation.

In premenopausal, anovulatory patients with insulin resistance, treatment with thiazolidinediones may result in resumption of ovulation. Due to improved insulin sensitivity, pregnancy can occur if adequate contraception is not used.

The pioglitazone in Actos has a moderate potential interaction with Pulmonary Edema.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Voriconazole has a moderate potential interaction with Renal Dysfunction.

The pharmacokinetics of voriconazole are not significantly altered by impaired renal function. However, accumulation of the IV vehicle, sulfobutyl ether beta-cyclodextrin sodium (SBECD), occurs in patients with moderate or severe renal dysfunction (CrCl less than 50 mL/min). The mean systemic exposure (AUC) and Cmax of SBECD were increased 4-fold and almost 50%, respectively, in moderately impaired patients compared to controls with normal renal function. The manufacturer recommends that oral voriconazole be used in patients with moderate to severe renal dysfunction, unless after assessing the benefit/risk to the patient, use of IV voriconazole is justified; serum creatinine levels should be monitored closely in these patients, and if increases occur, switching to oral voriconazole should be considered. No dosage adjustment is necessary when using oral voriconazole. Monitoring of renal function (including laboratory evaluation of serum creatinine) is recommended. Dosage adjustment has not been established in pediatric patients with renal dysfunction.

The pioglitazone in Actos has a moderate potential interaction with Weight Loss.

Thiazolidinediones can cause dose-related weight gain, which may be undesirable in obese patients attempting to lose weight. The mechanism of weight gain is unclear but probably involves a combination of fluid retention and fat accumulation. In postmarketing experience with rosiglitazone, there have been reports of unusually rapid increases in weight, greater than those generally observed in clinical trials. Patients who experience such increases should be assessed for fluid retention and volume-related events such as excessive edema and congestive heart failure.