Therapeutic drug monitoring van fluconazol bij gelijktijdige nierfunctiestoornis en interactie met rifampicine

Introduction Fungal infections are frequently treated with fluconazole. There is a clear relationship between efficacy and blood levels. Therapeutic drug monitoring (TDM) is not routinely performed because of predictable pharmacokinetics. However, these can be affected by renal dysfunction and other medicines like rifampicin. Description This case report shows fluconazole TDM in a setting with the combination of both renal dysfunction and rifampicin co-administration. Discussion The case shows that TDM of fluconazole has added value in case of the combination of both renal dysfunction and co-administration of rifampicin. Impaired renal function seems to limit the ability of rifampicin to interfere with the reabsorption route of fluconazole. This leads to unpredictable variations in fluconazole blood levels in which TDM offers a solution. Conclusion TDM is recommended in case exposure to fluconazole is unpredictable, for example when there is both renal dysfunction and rifampicin co-administration which affect kinetics in contrary manners.