Drug interactions between micafungin at high doses and cyclosporine A in febrile neutropenia patients after allogeneic hematopoietic stem cell transplantation

Abstract

OBJECTIVES: The aim of this study was to assess the drug interaction between high doses of micafungin and cyclosporine A (CyA) in allo-HSCT patients. METHODS: We assigned 15 patients to Groups 1, 2, or 3. We investigated the serial changes in the blood concentration/dose (C/dose) of intravenous CyA during micafungin coadministration in 5 patients during the switch from the prophylactic dose (150 mg/body) to the therapeutic dose (300 mg/body) of micafungin (Group 1), and compared each of the 5 patients in Group 1 with those who continued to receive the prophylactic doses of 150 mg or 50 mg/body of micafungin (Groups 2 and 3). We collected blood samples from patients in Group 1 receiving CyA at 0 h (C0) and (C3) 3 h on the 7th day after allo-HSCT, and on the 3rd and 10th days after escalation of the dose of micafungin to 300 mg. RESULTS: In Group 1, no significant difference was observed between C0/dose (2.11 ± 0.14) and C3/dose ratios of CyA (11.1 ± 5.34, p > 0.05) under 150 mg; the C0/dose and C3/dose ratios of CyA were 2.40 ± 0.60 and 10.8 ± 4.72 on the 3rd day and 2.23 ± 0.41 and 11.8 ± 3.06 on the 10th day, respectively, after dose escalation of micafungin to 300 mg. No significant differences were observed in those ratios between Groups 1 and 2 and between Groups 1 and 3. CONCLUSION: Thus, high dose of micafungin seems to be safe and does not significantly interact with CyA in allo-HSCT.