Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jan 22;7(2):76.
doi: 10.3390/jof7020076.

Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients

Megan E Klatt  1 , Gregory A Eschenauer  1
Affiliations
Review

Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients

Megan E Klatt et al. J Fungi (Basel). .

Abstract

Mold-active azole antifungals are commonly prescribed for the prevention of invasive fungal infections in lung transplant recipients. Each agent exhibits a unique pharmacologic profile, an understanding of which is crucial for therapy selection and optimization. This article reviews pharmacologic considerations for three frequently-used azole antifungals in lung transplant recipients: voriconazole, posaconazole, and isavuconazole. Focus is drawn to analysis of drug-interactions, adverse drug reactions, pharmacokinetic considerations, and the role of therapeutic drug monitoring with special emphasis on data from the post-lung transplant population.

Keywords: adverse reactions; antifungal drugs; azoles; interactions; lung transplant; therapeutic drug monitoring.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of voriconazole troughs after initial and subsequent doses in a sample of lung transplant recipients [3]. X-axis displays range of recorded voriconazole trough values in µg/mL. Y-axis describes percentage of patients within the respective voriconazole trough ranges. Reproduced with permission from American Society for Microbiology.
See this image and copyright information in PMC

References

    1. Pappas P.G., Alexander B.D., Andes D.R., Hadley S., Kauffman C.A., Freifeld A., Anaissie E.J., Brumble L.M., Herwaldt L., Ito J., et al. Invasive fungal infections among organ transplant recipients: Results of the Transplant-Associated Infection Surveillance Network (TRANSNET) Clin. Infect. Dis. 2010;50:1101–1111. doi: 10.1086/651262. - DOI - PubMed
    1. Patel T.S., Eschenauer G.A., Stuckey L.J., Carver P.L. Antifungal Prophylaxis in Lung Transplant Recipients. Transplantation. 2016;100:1815–1826. doi: 10.1097/TP.0000000000001050. - DOI - PubMed
    1. Mitsani D., Nguyen M.H., Shields R.K., Toyoda Y., Kwak E.J., Silveira F.P., Pilewski J.M., Crespo M.M., Bermudez C., Bhama J.K., et al. Prospective, observational study of voriconazole therapeutic drug monitoring among lung transplant recipients receiving prophylaxis: Factors impacting levels of and associations between serum troughs, efficacy, and toxicity. Antimicrob. Agents Chemother. 2012;56:2371–2377. doi: 10.1128/AAC.05219-11. - DOI - PMC - PubMed
    1. Husain S., Sole A., Alexander B.D., Aslam S., Avery R., Benden C., Billaud E.M., Chambers D., Isakov D.L., Fedson S., et al. The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: Executive summary. J. Heart Lung Transplant. 2016;35:261–282. doi: 10.1016/j.healun.2016.01.007. - DOI - PubMed
    1. Patterson T.F., Thompson G.R., 3rd, Denning D.W., Fishman J.A., Hadley S., Herbrecht R., Kontoyiannis D.P., Marr K.A., Morrison V.A., Nguyen M.H., et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin. Infect. Dis. 2016;63:e1–e60. doi: 10.1093/cid/ciw326. - DOI - PMC - PubMed

LinkOut - more resources