New database details antifungal drug-drug interactions

By Will Boggs MD

NEW YORK (Reuters Health) - A new, freely available database details possible interactions between antifungal agents and other drugs.

Fungal Pharmacology (https://www.fungalpharmacology.com), developed by Dr. Vincent J. Lempers and Dr. Roger J. Bruggemann from Radboud University Medical Center in Nijmegen, the Netherlands, aims to provide a comprehensive, up-to-date overview of drug-drug interactions (DDIs) with antifungals along with a description of the mechanisms and scientific evidence underlying them.

The database also offers tailor-made clinical advice on how to manage these interactions, the two explained in a report online November 8 in the Journal of Antimicrobial Chemotherapy.

Fungal Pharmacology includes all currently licensed antifungal drugs for treatment of invasive fungal diseases and more than 1,000 clinically important DDIs.

The authors' approach only allows for paired DDIs rather than predicting tertiary interactions with groups of three or more drugs, according to the report.

The creators have a four-person team that assesses updated information biweekly for possible inclusion in the database.

"Knowledge bases such as Fungal Pharmacology should not be used as a standalone solution, but rather should aid clinical decisions and support electronic health records by incorporating therapeutic drug monitoring data, patient demographics, laboratory tests (e.g. liver function tests and glomerular filtration rate values) and clinical information such as side effects, laboratory abnormalities and ECG read-outs," the authors conclude. "In this way, the clinical advice on the DDI with antifungal drugs could be even more patient specific, anticipating altered pharmacokinetic parameters in the target population."

Dr. Marisa Miceli from University of Michigan Health System's division of infectious diseases in Ann Arbor has published extensively on fungal diseases and their treatment. She told Reuters Health by email, "This app is a very interesting resource (and) accurately provides drug-drug interactions for most commonly used antifungal agents. Once you select the class of drug of interest, it provides a specific recommendation and the level of evidence supporting that recommendation. It also provides effect on QT interval. By clicking on specific drug of interest it prompts more details, including summary of product characteristics (SPC), which include indications, common, and severe side effects of the specific antifungal agent."

"I found it reliable, particularly because it has been tested by several experts in the field of fungal infections during its development and improved based on their feedback," said Dr. Miceli, who was not involved in creating the web tool. "Knowing the amount of effort and resources needed to develop and maintain an app like this, I also find this a generous resource because it can be downloaded free in your smartphone."

"Similar resources include Epocrates and Micromedex, but these resources are more complex and include the entire pharmacopeia," Dr. Miceli said. "These are apps that you can purchase and download in your smart-phone. Fungal Pharmacology has a very specific scope, limited to fungal drugs."

"Drug-drug interactions are important in daily practice, and it is impossible to remember all of them, particularly interactions of drugs you are not very familiar with or that you don't use every day," Dr. Miceli concluded. "This is a tool that can help those physicians prescribing antifungal agents."

Dr. Bruggemann did not respond to a request for comments.

SOURCE: https://bit.ly/1P4M7cS

J Antimicrob Chemother 2015.