Antifungina - Siematologia

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Profilassi Antifungina
SCHEDULE>> Raccomandazioni del Panel SIE PROFILASSI ANTIFUNGINA LEUCEMIA MIELOIDE ACUTA (INCLUSA APL) leucemia linfoblastica... LEUCEMIA MIELOIDE ACUTA (NON APL) in terapia di induzione e...
• Antifungal prophylaxis should be generally started concomitantly with chemotherapy.
• If chemotherapy includes drugs which are substrates of CYP enzymes (i.e. daunorubicina, etoposide, vinca alcaloids) antifungal therapy should be started 24-48 h after the discontinuation of chemotherapy.
• Antifungal prophylaxis should be administered until neutrophil recovery (>500/mmc for 2 consecutive days).
• Co-administration of triazoles and certain drugs is contraindicated due to possible drug-drug interactions (see below).  
• Triazoles (but not polyenes and echinocandins), are substrate of various CYP enzymes and their metabolism may be inhibited or induced by several drugs commonly used in hematologic patients
• Itraconazole, voriconazole and posaconazole are strong inhibitors and fluconazole is a moderate/weak inhibitor of the CYP3A4 enzymes.
• Several chemotherapy drugs (i.e. cyclophosphamide, vinca alcaloids, etoposide, daunorubicin) and tyrosine kinase inhibitors are substrates of the CYP3A4 enzymes (cyclophosphamide is substrate of both CYP3A4 and CYP2C9), therefore triazoles (in particular itraconazole, voriconazole and posaconazole for CYP3A4, fluconazole for both CYP3A4 and CYP2C9) may significantly inhibit their metabolism. The co-administration of triazoles with certain CYP substrates should be avoided or carefully considered."

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