伏立康唑
治疗药物监测
四分位间距
Cmin公司
医学
加药
氮氧化物
代谢物
药代动力学
内科学
药理学
最大值
化学
抗真菌
有机化学
皮肤病科
燃烧
作者
Christelle Boglione-Kerrien,Jeff Morçet,Lucie‐Marie Scailteux,François Bénézit,Christophe Camus,Jean-Baptiste Méar,Jean‐Pierre Gangneux,Éric Bellissant,Camille Tron,Marie‐Clémence Verdier,F. Lemaître
出处
期刊:Mycoses
[Wiley]
日期:2023-02-05
卷期号:66 (5): 396-404
被引量:3
摘要
Voriconazole (VRC), a widely used triazole antifungal, exhibits significant inter- and intra-individual pharmacokinetic variability. The main metabolite voriconazole N-oxide (NOX) can provide information on the patient's drug metabolism capacity.Our objectives were to implement routine measurement of NOX concentrations and to describe the metabolic ratio (MR), and the contribution of the MR to VRC therapeutic drug monitoring (TDM) by proposing a suggested dosage-adjustment algorithm.Sixty-one patients treated with VRC were prospectively included in the study, and VRC and NOX levels were assayed by LC-MS/MS. A mixed logistic model on repeated measures was implemented to analyse risk factors for the patient's concentration to be outside the therapeutic range.Based on 225 measurements, the median and interquartile range were 2.4 μg/ml (1.2; 4.2), 2.1 μg/ml (1.5; 3.0) and 1.0 (0.6; 1.9) for VRC, NOX and the MR, respectively. VRC Cmin <2 μg/ml were associated with a higher MR during the previous visit. MR values >1.15 and <0.48 were determined to be the best predictors for having a VRC Cmin lower than 2 μg/ml and above 5.5 μg/ml, respectively, at the next visit.Measurement of NOX resulted useful for TDM of patients treated with VRC. The MR using NOX informed interpretation and clinical decision-making and is very interesting for complex patients. VRC phenotyping based on the MR is now performed routinely in our institution. A dosing algorithm has been suggested from these results.
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