Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference-A Case Study.

IF 2.8 4区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Therapeutic Drug Monitoring Pub Date : 2024-06-01 Epub Date: 2024-04-26 DOI:10.1097/FTD.0000000000001179

Dario Cattaneo, Beatrice Caloni, Stefania Caronni, Nunziata Calvagna, Igor Bonini, Andrea Giacomelli, Cristina Gervasoni

{"title":"Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference-A Case Study.","authors":"Dario Cattaneo, Beatrice Caloni, Stefania Caronni, Nunziata Calvagna, Igor Bonini, Andrea Giacomelli, Cristina Gervasoni","doi":"10.1097/FTD.0000000000001179","DOIUrl":null,"url":null,"abstract":"Background: Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations.Methods: A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia. Over subsequent months, the patient underwent various changes in the doses (from 200 to 800 mg/d) and trough concentrations (from 3.6 to 18.0 mg/L) of CBZ, guided by clinical response to trigeminal neuralgia.Results: A highly significant inverse association was observed between darunavir trough concentration and both CBZ dose or trough concentration (coefficient of determination >0.75, P < 0.0001). Ultimately, the darunavir dose was increased to 600 mg twice daily with ritonavir and dolutegravir to ensure optimal antiretroviral coverage, anticipating potential further uptitration of CBZ doses.Conclusions: The impact of CBZ on boosted darunavir exposure seemed to be dose- and concentration-dependent. The management of such drug-drug interactions in daily practice was facilitated through therapeutic drug monitoring. This case underscores the importance of a multidisciplinary approach that incorporates both antiretroviral and nonantiretroviral comedications contributing to the optimal management of polypharmacy in individuals living with HIV.","PeriodicalId":23052,"journal":{"name":"Therapeutic Drug Monitoring","volume":"46 3","pages":"277-280"},"PeriodicalIF":2.8000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Drug Monitoring","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/FTD.0000000000001179","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/4/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations.

Methods: A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia. Over subsequent months, the patient underwent various changes in the doses (from 200 to 800 mg/d) and trough concentrations (from 3.6 to 18.0 mg/L) of CBZ, guided by clinical response to trigeminal neuralgia.

Results: A highly significant inverse association was observed between darunavir trough concentration and both CBZ dose or trough concentration (coefficient of determination >0.75, P < 0.0001). Ultimately, the darunavir dose was increased to 600 mg twice daily with ritonavir and dolutegravir to ensure optimal antiretroviral coverage, anticipating potential further uptitration of CBZ doses.

Conclusions: The impact of CBZ on boosted darunavir exposure seemed to be dose- and concentration-dependent. The management of such drug-drug interactions in daily practice was facilitated through therapeutic drug monitoring. This case underscores the importance of a multidisciplinary approach that incorporates both antiretroviral and nonantiretroviral comedications contributing to the optimal management of polypharmacy in individuals living with HIV.

查看原文本刊更多论文

卡马西平对达芦那韦低浓度的影响：卡马西平对达鲁那韦低浓度的影响：剂量决定成败--病例研究。

背景：卡马西平（CBZ）是一种抗癫痫药物，已知可诱导细胞色素P4503A代谢酶的表达。在此，我们描述了一名感染了艾滋病病毒的男性患者在多次改变 CBZ 的每日剂量后对达那韦谷浓度产生的不同诱导效果：一名 59 岁的男性艾滋病病毒感染者成功接受了每日一次达芦那韦/考比司他（联合雷特格韦）的维持性抗逆转录病毒治疗，并因反复发作的三叉神经痛服用了 CBZ。在随后的几个月中，患者根据三叉神经痛的临床反应，对CBZ的剂量（从200毫克/天到800毫克/天）和谷浓度（从3.6毫克/升到18.0毫克/升）进行了不同程度的调整：达芦那韦谷浓度与CBZ剂量或谷浓度之间存在非常明显的反比关系（决定系数>0.75，P<0.0001）。最终，达芦那韦的剂量增加到600毫克，每天两次，同时服用利托那韦和多鲁特韦，以确保最佳的抗逆转录病毒覆盖率，并预计CBZ剂量可能会进一步增加：结论：CBZ对达仑那韦暴露的影响似乎与剂量和浓度有关。通过治疗药物监测，有助于在日常治疗中处理此类药物相互作用。本病例强调了多学科方法的重要性，这种方法将抗逆转录病毒药物和非抗逆转录病毒药物结合在一起，有助于对艾滋病病毒感染者的多种药物进行优化管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Therapeutic Drug Monitoring 医学-毒理学

CiteScore

5.00

自引率

8.00%

发文量

213

审稿时长

4-8 weeks

期刊介绍： Therapeutic Drug Monitoring is a peer-reviewed, multidisciplinary journal directed to an audience of pharmacologists, clinical chemists, laboratorians, pharmacists, drug researchers and toxicologists. It fosters the exchange of knowledge among the various disciplines–clinical pharmacology, pathology, toxicology, analytical chemistry–that share a common interest in Therapeutic Drug Monitoring. The journal presents studies detailing the various factors that affect the rate and extent drugs are absorbed, metabolized, and excreted. Regular features include review articles on specific classes of drugs, original articles, case reports, technical notes, and continuing education articles.