Drug Interactions between troleandomycin and voriconazole

You may experience reduced absorption of voriconazole in the presence of food. Take voriconazole on an empty stomach 1 hour before or 2 hours after a meal unless otherwise directed by your doctor. This will make it easier for your body to absorb the medication.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

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.

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.

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.

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

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.

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.

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.

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 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.