Table 3.
Azoles in hematology-oncology. Recommendations
| Itraconazole | Posaconazole | Voriconazole | Isavuconazole | |
|---|---|---|---|---|
| Acalabrutinib | Avoid or reduce the dose of acalabrutinib to 100 mg/day | No dose titration. Monitor adverse effects | ||
| Bortezomib | Caution (1) | Probably without risk | ||
| Bosutinib | Avoid. Risk of QT prolongation due to elevated bosutinib concentrations | Caution. (2) Reduce the dose by 50% | ||
| Carfilzomib | Caution. Risk of QT prolongation | Without risk | ||
| Cyclophosphamide | Caution: May increase cyclophosphamide levels with potential risk of QT prolongation | Risk of potential ineffectiveness (3) | ||
| Cyclosporine | Caution. Elevated cyclosporine levels | Reduce cyclosporine dose by 75% | Reduce cyclosporine dose by 50 % | Caution (4) |
| Dasatinib | Avoid. Risk of QT prolongation due to elevated dasatinib concentrations | No dose titration. Monitor adverse effects | ||
| Doxorubicin | No dose titration. Monitor adverse effects | |||
| Duvelisib | Reduce duvelisib dose to 15 mg twice daily | No dose titration. Monitor adverse effects | ||
| Etoposide | No dose titration. Monitor adverse effects | |||
| Gilteritinib | Avoid or closely monitor | No dose titration. Monitor adverse effects | ||
| Glasdegib | Avoid. Risk of QT prolongation due to elevated glasdegib concentrations | Without risk | ||
| Ibrutinib | Avoid | Caution (5) | Caution (6) | |
| Idelalisib | Without risk | |||
| Imatinib | Caution (7) | |||
| Lenalidomide | No dose titration. Monitor adverse effects (8) | No dose titration | ||
| Midostaurin | Caution. Alternative drugs that do not strongly inhibit CYP3A4 activity should be considered. In situations where satisfactory therapeutic alternatives do not exist, patients should be closely monitored for midostaurin-related toxicity. | Monitor adverse effects | ||
| Nilotinib | The administration of nilotinib with drugs that are strong CYP3A4 inhibitors should be avoided (9) | No dose titration. Monitor adverse effects | ||
| Oxaliplatin | No dose titration. Monitor adverse effects (8) | No dose titration | ||
| Pomalidomide | No dose titration. Monitor adverse effects | |||
| Ponatinib | Caution, consider reducing the starting dose of ponatinib to 30 mg | No dose titration. Monitor adverse effects | ||
| Prednisone | Caution (10) | Caution (11) | ||
| Ruxolitinib | Caution | Reduce ruxolitinib dose by 50% | No dose titration. Monitor adverse effects | |
| Selinexor | No dose titration. Monitor adverse effects | |||
| Sirolimus | Avoid | Caution (4) | ||
| tacrolimus | Caution (12) | Reduce tacrolimus dose by one third | Caution (4) | |
| All-transretinoic acid | Caution (13) | No dose titration. Monitor adverse effects | ||
| Arsenic trioxide | Caution (8) | Without risk | ||
| Venetoclax | Avoid (14) | Reduce the daily dose by 50% | ||
| Vinblastine | Avoid | Caution (15) | Caution (16) | Caution (16) |
| Vincristine | Avoid | Caution (15) | Caution (16) | Caution (16) |
(1): Paralytic ileus cases have been described in patients treated with bortezomib, voriconazole or itraconazole.
(2) It can likely be used with caution since the contraindication is due to the risk of QT prolongation relating to increased concentrations due to CYP3A5 inhibition, which are lower with this drug.
(3): Isavuconazole is a mild inducer of CYP2B6.
(4) If necessary, monitor plasma levels to adjust the dose of the immunosuppressant.
(5): Reduce the dose to 140 mg/day in B-cell tumors and to 280 mg/day in the case of graft-versus-host disease. (6) Reduce the dose to 280 mg/day in B-cell tumors and to 420 mg/day in graft-versus-host disease.
(7) Careful monitoring of any incidence relating to drug toxicity. Reduce the dose if necessary.
(8) Potential risk; both drugs can prolong QT.
(9) Significant QT interval prolongation can occur when nilotinib is administered inappropriately with potent CYP3A4 inhibitors.
(10) Risk of increased corticosteroid concentrations. Monitor adverse effects.
(11) Co-administration should be avoided unless the potential benefit outweighs the risk of increased concentrations.
(12) Use only if there are no other alternatives.
(13): Increased tretinoin concentrations with risk of toxicity. Monitor plasma calcium levels and assess dose reduction.
(14) Avoid at initiation and during the dose-titration phase; risk of tumor lysis syndrome. Reduce the daily dose of venetoclax by 75% when administered as a fixed daily dose.
(15) Only use when there are no alternative antifungal treatment options.
(16) Risk of neurotoxicity due to high concentrations of alkaloids. It may be necessary to reduce the dose.