SYMPOSIUM 17: Dangerous liaisons: an interactive navigation into the antifungals DDI risk
Tracks
Track 1
| Wednesday, September 24, 2025 |
| 10:30 AM - 12:00 PM |
| Grand Copthorne Waterfront Hotel - Grand Ballroom I |
Details
The aim of this workshop is to provide the audience with interactive discussions around drug-drug interactions (DDI) situations with the antifungal drugs. Questions will be asked to the audience using a poll system and the following topics will be highlighted: difference between DDI potential with different antifungals, particularity of interaction on specific pathways, impact of drug administration modalities on the effect of DDI, concentration-inhibition effect, and effect of genotype on DDI. The principles of DDI identification, pre-emptive drug dosage adjustments and therapeutic drug monitoring role to prevent adverse drug reactions in the context of a DDI situation will be described.
The symposium will be set-up in three talks: the first entitled “The Usual Suspects: classic DDI with antifungal drugs (azoles, echinocandines and liposomal amphotericin B) and how to avoid/act on them; the second “Lost in translation: a presentation on some controversial DDI examples” aiming at making the audience aware of these DDI and the last one “Deep impact: the role of inflammation and genetics on antifungal DDI”, where the modulation of DDI by these extrinsic and intrinsic factors will be discussed with the audience.
Speaker
Mr Andre Wieringa
Isala Hospital
The Usual Suspects: the classic DDI with antifungal drugs
Abstract
In this workshop an interactive overview will be given on the relevant drug-drug interactions in antifungal treatment, which are frequently encountered in daily clinical practice.
Biography
Andre Wieringa is a hospital pharmacist and clinical pharmacologist in the Isala Hospital and Erasmus MC with special interest in the ICU and antimicrobials. He is a trainer in clinical pharmacology in the Isala Hospital and is also a researcher on the ICU with special interest in optimising dosing of antimicrobials in critically ill patients. He focusses on:
1.) the pharmacokinetics of antimicrobials in ICU patients undergoing continuous renal replacement therapy, and
2.) model building to identify which patients are at risk of target non-attainment with beta-lactam and quinolone antibiotics, which may help guide dosing in patients with potentially low concentrations of antibiotics.
Miss Fay Burrows
Pharmacy Department, St. Vincent's Hospital
Lost in translation: a presentation on some controversial DDI examples
Abstract
Drug interactions with azole antifungals are well documented, with azoles acting as both substrates and inhibitors of the cytochrome P450 enzyme family. These pharmacokinetic interactions are usually easy to predict and can invariably be managed with therapeutic drug monitoring and appropriate dose adjustment. However, an increasing number of case reports have identified an unexpected interaction between flucloxacillin and certain azole antifungals, resulting in sub-therapeutic azole levels and potential treatment failure. Although several suggestions have been made as to the mechanism of this presumed enzyme-induction interaction, it remains undetermined. This interactive session will describe our experience with the suspected interaction between flucloxacillin and voriconazole, and the added complexity of a three-way interaction between flucloxacillin, voriconazole and tacrolimus in heart and lung transplant recipients. Potential mechanisms behind this interaction will be evaluated, and the possibility of other beta-lactam antibiotics having a similar interaction with azole antifungals will be discussed. In addition this session will introduce other potentially controversial and unexpected interactions with antifungal agents.
Biography
Fay Burrows is the Senior Pharmacist for Heart and Lung Transplant at St Vincent's Hospital in Sydney, Australia. She is the current chair of the Pharmacy Professional Community of the International Society for Heart and Lung Transplant and has contributed to several consensus and guideline documents for ISHLT. She is affiliated with the University of Sydney and her research interests include transplant infectious diseases and antimicrobial/immunosuppressant drug interactions.
Dr Haifa Lyster
Harefield’s Hospital, Part Of Gstt
Deep impact: the role of inflammation and genetics on antifungal DDI
Abstract
Antifungal drug-drug interactions (DDIs) pose significant challenges in clinical practice, often leading to altered drug efficacy, toxicity, or treatment failure, especially in immunocompromised populations where polypharmacy is common. Emerging evidence highlights the critical influence of inflammation and genetic variability on these interactions. This presentation explores how systemic inflammation modulates drug-metabolizing enzymes (e.g., cytochrome P450) and transporters, potentially altering antifungal pharmacokinetics. Additionally, genetic variations in key metabolic enzymes such as CYP3A4, CYP2C19, influence individual susceptibility to DDIs, potentially exacerbating toxicity or diminishing efficacy Understanding the interplay between inflammation, genetics, and antifungal DDIs is essential for precision medicine and improving therapeutic outcomes.
Biography
Dr Lyster is a Fellow of the Royal Pharmaceutical Society and its’ Faculty. She is the consultant pharmacist in Cardiothoracic Transplantation and Mechanical Circulatory Support at Royal Brompton & Harefield Hospitals, managing the pharmaceutical care of VAD/ECMO and heart/lung transplant patients. Dr Lyster is on the board of Directors of the International Society of Heart & Lung Transplantation, having held several leadership roles within the society. She co-founded and is the Chair of Solid Organ Transplant Pharmacy Association with colleagues from renal and liver transplantation delivering an annual conference since 2013 supporting pharmacists in SOT, membership and attendance of pharmacists across Europe. She has completed a research doctorate developing Pharmacokinetic models of antifungal agents in critically ill patients with ECMO; and commenced a NIHR Senior Clinical and Practitioner Research Award R1, her research interests include personalisation of dosing in special populations e.g. critically ill patients with or without ECMO, RRT.
Session chair
Florian Lemaitre
Rennes University Hospital
Isabel Spriet
University Hospitals Leuven
