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International Journal of Clinical Pharmacy

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07-12-2024 | Esomeprazole | Research Article

Effectiveness of combined proton pump inhibitors and posaconazole prophylaxis against invasive fungal infections in patients with hematologic malignancies: a retrospective study

Authors: Yan Liu, Ruochen Qu, Yan Zhao, Ziyi Wang, Shizhao Yuan, Shuai Liu, Chunhua Zhou, Jing Yu

Published in: International Journal of Clinical Pharmacy | Issue 2/2025

Abstract

Background

Posaconazole is widely recommended for preventing and treating invasive fungal infections (IFIs) in immunocompromised patients, especially those with prolonged neutropenia. However, the concentration of the oral suspension formulation can be affected by factors such as co-administration with acid-suppressing medications, influencing its efficacy and safety.

Aim

This study examined the impact of proton pump inhibitors (PPIs) and other factors on posaconazole concentrations and the concentration-to-dose ratio (C/D) while also evaluating adverse drug reactions in patients with hematologic malignancies.

Method

We conducted a retrospective analysis of patients who received posaconazole for IFI prophylaxis or treatment, assessing demographic and clinical data, adverse reactions, treatment outcomes, and drug concentration assays. The study focused on the effects of PPIs on Cmin and C/D.

Results

Data from 283 posaconazole Cmin measurements in 86 patients were analyzed. The incidence of probable or proven IFIs was 6.4% (5/78). PPI use reduced posaconazole Cmin levels but did not significantly impact prophylactic efficacy. Esomeprazole and rabeprazole were explicitly associated with decreased Cmin. Hepatotoxicity was linked to the co-administration of hepatotoxic drugs, indicating that posaconazole was not the sole contributor.

Conclusion

Co-administration of esomeprazole or rabeprazole lowers posaconazole plasma concentrations without compromising prophylactic efficacy against IFIs. Nonetheless, caution is advised when combining these drugs in high-risk immunocompromised patients.

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Title: Effectiveness of combined proton pump inhibitors and posaconazole prophylaxis against invasive fungal infections in patients with hematologic malignancies: a retrospective study
Authors: Yan Liu
Ruochen Qu
Yan Zhao
Ziyi Wang
Shizhao Yuan
Shuai Liu
Chunhua Zhou
Jing Yu
Publication date: 07-12-2024
Publisher: Springer International Publishing
Keywords: Esomeprazole
Rabeprazole
Proton Pump Inhibitors
Published in: International Journal of Clinical Pharmacy / Issue 2/2025
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI: https://doi.org/10.1007/s11096-024-01841-8

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Effectiveness of combined proton pump inhibitors and posaconazole prophylaxis against invasive fungal infections in patients with hematologic malignancies: a retrospective study

Abstract

Background

Aim

Method

Results

Conclusion

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Pharmacists’ perspectives on potential pharmacist prescribing: a nationwide survey in the Netherlands

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Abstract

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