From the Literature
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From the Literature Case Reports
Springer International Publishing Switzerland 2012
This section of the journal is intended to provide coverage of published adverse reaction case reports in relation to genetic diagnoses, pharmacogenetic findings, and individualized use of molecularly targeted therapies. These case reports have been published in recent issues of Reactions, another Adis Journals publication; more information can be found at http://adisonline.com.
1 Anti-Infectives and Vaccines 1.1 Atazanavir: Hyperbilirubinemia, Pruritus, and Hyperlipidemia A man in his 50s developed episodes of hyperbilirubinemia, pruritus, and hyperlipidemia during treatment with atazanavir for HIV-1 infection. The man was diagnosed in 1999 and started receiving atazanavir 300 mg once daily, ritonavir, didanosine, and lamivudine in January 2005. A few months later, he developed grade III hyperbilirubinemia, severe and persistent itching, and poor metabolic control. All events were considered to be potentially related to atazanavir. In November 2007, atazanavir was increased to 400 mg/day. His laboratory parameters improved, but he continued to have mild hyperlipidemia and episodes of itching. Because of the man’s symptoms, atazanavir was reduced to 300 mg once daily in September 2009. His symptoms and laboratory parameters improved further, but he still reported episodes of severe and persistent itching. He was admitted to the hospital following a routine outpatient visit in February 2010 at 59 years of age. Daily atazanavir pharmacokinetic profiles revealed very low trough concentrations and high maximum
concentrations, indicating rapid drug absorption followed by rapid drug clearance. Genetic studies showed that he was heterozygous for an allelic variant of the ABCB1 gene, which is associated with reduced P-glycoprotein activity, leading to atypical pharmacokinetics of atazanavir. He was switched to atazanavir 200 mg twice daily in March 2010, and his atazanavir pharmacokinetic parameters normalized. At the last follow-up in August 2010, his episodes of itching had resolved. Cattaneo D, Meraviglia P, Cozzi V, et al. Atypical pharmacokinetics of atazanavir in an HIV-1-infected patient. Fundam Clin Pharmacol 2012 Apr; 26 (2): 204–6
1.2 Voriconazole: Visual Hallucinations and Elevated Liver Enzymes A 43-year-old woman developed visual hallucinations and elevated liver enzymes during treatment with oral voriconazole. The woman, who had completely lost her vision in her left eye because of relapsing Wegener’s granulomatosis, was admitted for investigation of blurring of the vision in her right eye. Fundoscopy showed a juxtafoveal lesion, which was suspicious for fungal retinitis. She was treated with voriconazole 400 mg twice daily on day 1, thereafter followed by 200 mg twice daily. Her other medications included ganciclovir, foscarnet, and sulfadiazine. Seven days after starting voriconazole, she developed frequent visual hallucinations. Two days later, she had abnormal liver function test results, with the following valu
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