Effect of CYP inhibitors on the pharmacokinetics and safety of voriconazole: a systematic review and meta-analysis
Objective To systematically assess the effect of CYP450 inhibitors on the pharmacokinetics and safety of VORI.Methods: Cochrane Library, PubMed, Embase, CNKI, CBM and WanFang databases were searched up to January 26th 2016.Meta analyses were performed with RevMan5.3, and risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.Results: Seventeen studies were included: 1 parallel RCT, 5 cross-over RCTs, 4 single-arm before-and-after studies, 6 cohort studies and 1 case report.Compared with no-combined group, the group of VORI plus omeprazole had a significantly higher occurrence of hepatic dysfunction (RR =4.11, 95% CI 1.12-15.08, P =0.03);however,no difference of neurologic dysfunction was found between VORI plus omeprazole and control group (RR =5,20, 95% CI 0.52-52.47, P =0.16).Similarly for the Cminof VORI, there was no difference between combined and no-combined omeprazole groups (MD =0.18, 95% CI 0.00-0.36, P=0.05).Pantoprazole, rabeprazole, cimetidine, erythromycin and contraceptive significantly increased the peak concentration and concentration-time curve (AUC) of VORI;however, indinavir and etravirine had no significant effect.The variation of pharmacokinetic parameters of VORI co-administeredwith esomeprazole,azithromycin and ritonavir indicated conflict effects.Conclusions: Co-administration of VORI and CYP450 inhibitors was safe except omeprazole.Although the Cmax and AUC of VORI were increased while co-administrated with CYP450 inhibitors,no significantly effect on clinical practice was observed.
Voriconazole CYP450 inhibitors Systematic review Meta-analysis
Huixia Yang Ken Chen Shiyao Liang Zhanmiao Yi S.D.Zhai
Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China;Department of Pharm Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China;Department of Pharm Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China
国内会议
南昌
英文
654-661
2016-09-27（万方平台首次上网日期，不代表论文的发表时间）