[Drug interactions in critically-ill patients. An important factor in the use of XXXX ?].

@entity1331 @entity8 @entity1262 @entity25928 @entity2379 @entity12365 @entity2380 @entity5322 @entity364 @entity5626 @entity7143 @entity8201 @entity5638 @entity2059 @entity11794
Currently there are three main drug groups for the prevention and treatment of @entity364 : @entity12365 ( @entity2379 deoxycholate or its lipid formulations), @entity8201 ( @entity2380 , @entity2059 or @entity7143 ) and @entity5626 ( @entity11794 , @entity1331 and @entity25928 ). However, a major characteristic to be evaluated when choosing an antifungal agent -apart from antifungal spectrum, pharmacokinetics and adverse effects- is the absence of significant drug interactions. @entity2379 lacks interactions but may cause @entity8 , leading to the accumulation of renally metabolized drugs. Nephrotoxicity is significantly lower with lipid formulations, especially with liposomal @entity2379 . Azoles modify the metabolism of a wide range of drugs by inhibiting their biotransformation or altering their distribution and elimination. These drugs are metabolized in the liver through the P450 cytochrome complex, inhibiting several isoenzymes, especially @entity5322 , the main drug-metabolizing enzyme. Moreover, @entity2059 and @entity7143 are substrates and inhibitors of the transporter protein, @entity1262 . @entity2380 is the @entity5638 with the fewest drug-drug interactions. The @entity5626 have increased the therapeutic arsenal and a particular feature of these drugs is their safety, due to the absence of severe adverse effects and the scarce number of interactions. The echinocandin with the highest number of interactions is caspofungin. @entity1331 is an echinocandin lacking in relevant interactions and consequently its dosage requires no adjustment in any of its indications. This drug can be used both in adults and in the pediatric population, including neonates.
