Drugs suspected to be involved in the DDI-summary
Complete list of drugs taken by the patient
Fluconazole, atorvastatin, cloxacillin, enalpril, enoxaparin, metamizol, insulin, paracetamol, omeprazol
Clinical case description
This is a HIV patients with an acute infection of a hip prothesis caused by a Candida rugosa, that was isolated in surgical cultures and treated with fluconazol. Fluconazol inhibits etravirine metabolism and coadministration may increase etravirine exposures (AUC by 86%, Cmax by 75%, Cmin by 2.09-fold) while it has no significant effect on fluconazole exposure. No dose adjustments were done. The patient presented a multifactorial severe anemia that may be worsened by an increased exposure to etravirine and that improved when fluconazole treatment was stopped.
Drug Interaction Probability Scale (DIPS)
Coadministration significantly increased etravirine exposures (AUC by 86%, Cmax by 75%, Cmin by 2.09-fold) and had no significant effect on fluconazole exposure. Although no dose adjustments are needed, etravirine and fluconazole should be coadministered with caution as there are limited safety data on increased etravirine exposure. Anemia is among common laboratory abnormalities (4%) in etravirine prescribing information, although no clear relationship with etravirine concentrations has been described.