Antifungal agents - clinical pharmacokinetics and drug interactions

Achievement of therapeutic drug levels appears to be mandatory when antifungal agents are used for the treatment of manifest mycoses. Based on the marked interindividual variability of trough levels, Therapeutic Drug Monitoring is of increasing concern during treatment with itraconazole, voriconazole or posaconazole. In addition, a broad spectrum of potential drug interactions has to be kept in mind during triazole treatment. In contrast, echinocandins reveal a more comfortable class of antifungal agents in this regard with no obvious incidence of nephrotoxic side effects compared to amphotericin B and its lipid formulations.