Antifungal drug interactions database and apps for iPhoneand Android

Ref ID: 19583

Author:

GT Atherton1*, S Banfield1, J Bartholomew1, DW Denning1

Author address:

1National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Introduction: Drug:drug interactions (DDIs) account for 3-5% of serious adverse reactions, which themselves are common causes of hospital admission and sometimes death. In 433 patients >60 years old taking at least 2 agents, the incidence of DDI-related ADRs was 6.5%. Systemic azole antifungal medications have a high potential to cause DDIs with many drugs. Some interactions reduce the efficacy of azoles (ie rifamycins), others the efficacy of the interacting drug (ie low dose ritonavir), or lead to excess concentrations of the interacting drug (ie ciclosporin, warfarin, digoxin, benzodiazepines etc). Some interactions occur with amphotericin B and echinocandins. Both medical professionals and patients (& carers) need support in this area because of the range and complexity of possible interactions. We have created a quick reference for guidance. Methods: Information on interactions with itraconazole, voriconazole, posaconazole, fluconazole, amphotericin B, micafungin and caspofugun has been collated from a number of sources: manufacturers’ Summary of Product Characteristics, Stockley’s Drug Interactions, consideration of the effects of each drug on CYP P450 isoenzymes & p-glycoprotein, clinical considerations and primary literature. For each interacting pair of drugs the interaction is classified as of ’major’ (red), ’moderate’ (amber) or ’minor’ (green) significance. ’Major’ interactions are those that could cause significant harm, even if rare & which require avoidance, with ’minor’ interactions generally increasing the risk of one or more adverse effects. Where no interaction is expected there is no entry. For each interacting pair of drugs, patients are informed of the action their doctor should be taking & effects to look out for. Doctors are provided with the mechanism of the interaction, evidence of an existing interaction and action to take. Results: We have constructed a searchable database of interactions between systemic antifungal drugs and every other prescribed drug currently available to provide a reference for both doctors and patients. The information is provided free of charge at The Aspergillus Website (www.antifungalinteractions. org) and for convenience and maximum accessibility is also available as an APP for smartphones both for iPhones and Android devices (’Antifungal Interactions’). There are 739 drugs listed and 8 antifungals. 398 interactions are rated as minor, 1375 moderate and 443 severe, a total of 2216 recorded interactions. The user simply chooses the drug they wish to investigate from a list and with one button click they will be taken to a ’traffic light’ system of warnings – green for minor, orange for moderate and red for severe interaction. If there is no interaction noted or known this is also indicated. The online database is updated regularly with additional publications and constant review. The app database is updated every 6 months. It will shortly be available in a new form that will be more useful to doctors and other medical professionals, written out in a far more detailed format for professional use. Conclusion: A DDI resource is available for antifungal drug interactions, to reduce adverse drug reactions and loss of antifungal efficacy.

Abstract Number: 108

Conference Poster: y

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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