Busulfan Concentrate Injection and Vfend

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Voriconazole may increase the blood levels of busulfan. This may increase side effects such as nausea, vomiting, diarrhea, mouth sores, liver problems, breathing difficulties, irregular heartbeat, hallucinations, seizures, confusion, and impaired bone marrow function resulting in low numbers of different types of blood cells. You may also be more likely to develop anemia, bleeding problems, or infections due to low blood cell counts. You should contact your doctor if you develop paleness, fatigue, dizziness, fainting, unusual bruising or bleeding, fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. Also seek immediate medical attention if you have signs and symptoms of liver damage such as fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark colored urine, light colored stools, and/or yellowing of the skin or eyes. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Itraconazole has been reported to inhibit the clearance of busulfan. The mechanism of interaction has not been established. Itraconazole is a potent inhibitor of the CYP450 3A4 isoenzyme and P-glycoprotein (P-gp) efflux transporter, although there is little evidence to suggest that busulfan is a substrate of either. In one study, mean busulfan clearance decreased by approximately 18% in bone marrow transplant patients who received itraconazole 6 mg/kg once daily compared to matched controls who did not receive itraconazole, resulting in 24% higher steady-state concentrations. The clinical significance of these changes is unknown. In contrast, patients who received fluconazole showed no difference in busulfan clearance relative to controls. Whether, or how, other azole antifungal agents may affect the clearance of busulfan is uncertain. In a study of 136 pediatric autologous bone marrow transplant patients who received high-dose busulfan as part of a conditioning regimen, concomitant ketoconazole therapy was identified as a risk factor for the development of hepatic veno-occlusive disease (HVOD). Since HVOD may be a concentration-dependent toxicity of busulfan, the study data would suggest a pharmacokinetic interaction with ketoconazole. No data are available for posaconazole or voriconazole, which are known inhibitors of CYP450 3A4 but not P-gp, although posaconazole is a substrate for P-gp.

MANAGEMENT: Patients prescribed busulfan with itraconazole or ketoconazole should be monitored for potentially increased myelotoxic, hepatotoxic, neurotoxic, and gastrointestinal toxic effects. Some experts also recommend the same precaution during coadministration with posaconazole or voriconazole, although clinical data are lacking.

Busulfan Concentrate Injection

Generic Name: busulfan

Brand name: Busulfex, Myleran

Synonyms: Busulfan (oral/injection), Busulfan

What is Busulfan Concentrate Injection?

Vfend

Generic Name: voriconazole

Brand name: Vfend, Vfend

Synonyms: Vfend Injection

What is Vfend?