Voriconazole interaction with Acalabrutinib

Hello All,

Any leads on the interaction of voriconazole with Acalabrutinib ?

My father had been diagnosed with Cryptococcosis fungallung infection on November 2022. since then he was in voriconazole . Now he was about to start acalabrutinib ?

but again recent CT scan reveals:

-two soft tissue nodules in anterior segment of right upper lobe and centrilobular region of apical segment of left lower lobe

-multiple small centrilobular soft tissue nodules, adjacent ground glass opacities and atelectatic bands in anterior segment of right upper lobe

Any one here in this forum been infected of fungal lung infection along with CLL ?

[AussieNeil Administrator]

Per drugs.com/interactions-chec...

Voriconazole can significantly increase the blood levels of acalabrutinib. This may increase side effects such as nausea, vomiting, diarrhea, abdominal pain, hemorrhage, development of other cancers, abnormal heart rhythm, and impaired bone marrow function resulting in low numbers of different types of blood cells. You may also be more likely to develop anemia, bleeding problems, or infections due to low blood cell counts. Talk to your doctor if you have any questions or concerns.....

[lankisterguy Volunteer]

Hi Mydadsuperman,

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We had one member of our support group in New York City that needed Voriconazole and when he started Venetoclax the doctors carefully balanced the two drugs to find that he could only tolerate 50mg of Venetoclax daily vs. the normal dose of 400mg. The last time we spoke, he was doing OK on the combination.

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As  AussieNeil quotes your dad's doctor in India may be able to confer with a CLL expert and get advice on dose reduction / dose scheduling if he experiences troublesome side effects from the combination. The experts may be able to advise a longer time period between taking one capsule or tablet since the Voriconazole may be keeping the Acalabrutinib in his blood much longer than normal.

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See: pubmed.ncbi.nlm.nih.gov/263....

Drawbacks to the use of voriconazole are that it has unpredictable, nonlinear pharmacokinetics with extensive interpatient and intrapatient variation in serum levels. Some of the adverse effects seen with voriconazole are related to high serum concentrations, and, as a result, therapeutic drug monitoring is essential when using this agent. Drug-drug interactions are common, and possible interactions must be sought before voriconazole is prescribed. With prolonged use, newly described adverse effects, including periostitis, alopecia, and development of skin cancers, have been noted.

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Len