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Vol. 29. Núm. S2.
Micafungina: nuevos retos y nuevas posibilidades en el tratamiento de la infección fúngica invasora
Páginas 33-37 (Marzo 2011)
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Vol. 29. Núm. S2.
Micafungina: nuevos retos y nuevas posibilidades en el tratamiento de la infección fúngica invasora
Páginas 33-37 (Marzo 2011)
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Interacciones farmacológicas en el paciente crítico. ¿Un factor relevante para usar micafungina?
Drug interactions in critically-ill patients. An important factor in the use of micafungin?
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José Garnacho-Monteroa,��
Autor para correspondencia
jgarnachom@telefonica.net

Autor para correspondencia.
, Francisco Jiménez Parrillab
a Unidad Clínica de Cuidados Críticos y Urgencias, Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, España
b Unidad Clínica de Cuidados Críticos y Urgencias Pediátricos, Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
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Bibliografía
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Resumen

Actualmente disponemos de 3 grupos de fármacos principales para la prevención y tratamiento de la infección fúngica: polienos (anfotericina B deoxicolato o sus formulaciones lipídicas), azoles (fluconazol, itraconazol, voriconazol o posaconazol) y equinocandinas (caspofungina, micafungina y anidulafungina). Una de las características importantes, además del espectro antifúngico, farmacocinética y efectos adversos, que se valora a la hora de elegir un antifúngico es la ausencia de interacciones farmacológicas significativas. Anfotericina B carece de interacciones, si bien puede ocasionar disfunción renal que puede causar acumulación de los fármacos con metabolismo renal. La nefrotoxicidad es significativamente menor con las formulaciones lipídicas, en especial con la anfotericina B liposomal. Por contra, los azoles modifican el metabolismo de muy diversos fármacos por inhibir su biotransformación o alterar su distribución y eliminación. Tienen un metabolismo hepático a través del citocromo P450 inhibiendo diversas isoenzimas, en especial CYP3A4, que es la principal enzima metabolizadora de fármacos. Además, itraconazol y posaconazol son sustratos e inhibidores de la proteína transportadora glucoproteína-P. Fluconazol es el azol que presenta menor número de interacciones medicamentosas. Las equinocandinas han supuesto un avance en nuestro arsenal terapéutico destacando la seguridad en su empleo, que se debe a la ausencia de efectos adversos graves y al escaso número de interacciones, siendo caspofungina la que presenta un número más elevado de interacciones. Micafungina es una equinocandina que no presenta interacciones relevantes, por lo que no es preciso el ajuste de su dosis en ningún caso y puede emplearse tanto en adultos como en población pediátrica, incluyendo los neonatos.

Palabras clave:
Farmacocinética de antifúngicos
Interacción de fármacos
Micafungina
Equinocandinas
Abstract

Currently there are three main drug groups for the prevention and treatment of fungal infections: polyenes (amphotericin B deoxycholate or its lipid formulations), azoles (fluconazole, itraconazole or posaconazole) and echinocandins (caspofungin, micafungin and anidulafungin). However, a major characteristic to be evaluated when choosing an antifungal agent —apart from antifungal spectrum, pharmacokinetics and adverse effects— is the absence of significant drug interactions. Amphotericin B lacks interactions but may cause renal dysfunction, leading to the accumulation of renally metabolized drugs. Nephrotoxicity is significantly lower with lipid formulations, especially with liposomal amphotericin B. Azoles modify the metabolism of a wide range of drugs by inhibiting their biotransformation or altering their distribution and elimination. These drugs are metabolized in the liver through the P450 cytochrome complex, inhibiting several isoenzymes, especially CYP3A4, the main drug-metabolizing enzyme. Moreover, itraconazole and posaconazole are substrates and inhibitors of the transporter protein, P-glycoprotein. Fluconazole is the azole with the fewest drug-drug interactions. The echinocandins have increased the therapeutic arsenal and a particular feature of these drugs is their safety, due to the absence of severe adverse effects and the scarce number of interactions. The echinocandin with the highest number of interactions is caspofungin. Micafungin is an echinocandin lacking in relevant interactions and consequently its dosage requires no adjustment in any of its indications. This drug can be used both in adults and in the pediatric population, including neonates.

Keywords:
Antifungal pharmacokinetics
Drug interactions
Micafungin
Echinocandins
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Copyright © 2011. Elsevier España S.L.. Todos los derechos reservados
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