Utilization of omeprazole to augment subtherapeutic voriconazole concentrations for treatment of Aspergillus...

Area of Science:

• Mycology
• Pharmacology
• Infectious Diseases

Background:

• Voriconazole is a key antifungal for Aspergillus infections.
• Therapeutic drug monitoring (TDM) is crucial for optimizing voriconazole efficacy and safety.
• Challenges like variable pharmacokinetics and drug interactions can lead to subtherapeutic levels.

Observation:

• A patient with Aspergillus infection experienced persistently low voriconazole trough concentrations despite standard dosing.
• This patient was also taking omeprazole, a proton pump inhibitor.

Findings:

• A significant "boosting" effect of omeprazole on voriconazole levels was observed.
• Omeprazole co-administration helped achieve target voriconazole concentrations in this patient.
• This suggests a potential interaction that increases voriconazole bioavailability or reduces its clearance.

Implications:

• Omeprazole may be a useful adjunct for "boosting" voriconazole levels in specific patient populations.
• This interaction warrants further investigation to understand the underlying mechanisms.
• Consideration of omeprazole co-administration could be valuable in managing difficult-to-treat Aspergillus infections requiring voriconazole therapy.