Drug Interaction Report

MONITOR: Coadministration of daclizumab with other agents known to induce hepatotoxicity may increase the risk of liver injury. Serious drug-related hepatic injury, including liver failure and autoimmune hepatitis, has been reported across controlled and open-label studies in 1.7% of daclizumab-treated patients and may occur at any time during treatment and up to 5 months after treatment cessation. Fatal cases have occurred. In addition, cases of hepatic injury have occurred in patients taking daclizumab concomitantly with other hepatotoxic drugs; however, the contributory role of these other medicines has not been established.

MANAGEMENT: Caution is advised if daclizumab is used with other potentially hepatotoxic agents, including non-prescription products and herbal supplements. Patients treated with daclizumab should have serum transaminase levels and total bilirubin measured prior to initiation of treatment and monthly during treatment in accordance with the manufacturer's recommendations, and the dosing adjusted or interrupted as necessary. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, right upper quadrant pain, dark urine, pale stools, and jaundice.

ADJUST DOSING INTERVAL: Food reduces the oral absorption and bioavailability of voriconazole. According to the product labeling, administration of multiple doses of voriconazole with high-fat meals decreased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by 34% and 24%, respectively, when the drug is administered as a tablet, and by 58% and 37%, respectively, when administered as the oral suspension.

MANAGEMENT: To ensure maximal oral absorption, voriconazole tablets and oral suspension should be taken at least one hour before or after a meal.