Sirolimus/voriconazole interaction
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Rhabdomyolysis: case report Ten days after commencing voriconazole 300mg 12-hourly for pulmonary aspergillosis [route not stated], a 42-year-old female liver transplant presented with altered mental status, visual disturbances, fatigue and nausea. In addition to the transplant, her medical history was notable for stage IV chronic kidney disease and she was receiving sirolimus concomitantly [dosage and route not stated]. Laboratory investigations revealed increases from baseline in creatine kinase, serum creatinine and liver enzyme tests, and her voriconazole and sirolimus concentrations were supratherapeutic. Both drugs were withheld. The woman developed fulminant hepatic failure and acute-on-chronic renal failure leading to her death. Author comment: "Both voriconazole and sirolimus are substrates and inhibitors of cytochrome P450 enzymes. Coadministration of voriconazole and sirolimus is contraindicated". Nelson S, et al. Drug-induced rhabdomyolysis following voriconazole therapy: a case report. Critical Care Medicine 38 (Suppl.): abstr. 991, No. 12, 2010. Available 801160703 from: URL: http://www.sccm.org - USA
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Reactions 16 Jul 2011 No. 1360
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