Publications by authors named "Jose Ramón Azanza-Perea"

7 Publications

  • Page 1 of 1

[Pharmacological profile of isavuconazole].

Rev Iberoam Micol 2018 Oct - Dec;35(4):186-191. Epub 2018 Nov 23.

Servicio de Farmacología Clínica, Clínica Universidad de Navarra, Pamplona, España.

Isavuconazole is a new azole, structurally related to fluconazole and voriconazole, that presents a very high oral absorption with no first-pass effect which is not interfered by the presence of food, gastric pH modifications, or mucositis. Its distribution volume is very high, probably also to cerebrospinal fluid, in spite of the fact that it circulates highly bound to plasma proteins. It is extensively metabolized through the CYP3A4 isoenzyme. Due to this reason, it is recommended to avoid co-administration with strong CYP3A4 inducers. In addition, isavuconazole may inhibit CYP3A4. Moreover, it may induce CYP2B6 and P-glycoprotein. Interestingly, this inhibitory activity seems to be lower compared to other azoles. Therefore, the management of any interaction with other medicines is easier, which is probably the most important advantage of this antifungal.
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http://dx.doi.org/10.1016/j.riam.2018.04.003DOI Listing
June 2019

[Echinocandins: Applied pharmacology].

Rev Iberoam Micol 2016 Jul-Sep;33(3):140-4. Epub 2016 Jul 6.

Servicio de Farmacología Clínica, Clínica Universidad de Navarra, Pamplona, Navarra, España. Electronic address:

The echinocandins share pharmacodynamic properties, although there are some interesting differences in their pharmacokinetic behaviour in the clinical practice. They are not absorbed by the oral route. They have a somewhat special distribution in the organism, as some of them can reach high intracellular concentrations while, with some others, the concentration is reduced. They are highly bound to plasma proteins, thus it is recommended to administer a loading dose for anidulafungin and caspofungin, although this procedure is not yet clear with micafungin. Echinocandins are excreted via a non-microsomal metabolism, so the urinary concentration is very low. Some carrier proteins that take part in the biliary clearance process are probably involved in the interactions described with caspofungin and micafungin. These two drugs must be used with caution in patients with severely impaired hepatic function, while all of them can be used without special precautions when there is renal impairment or the patient requires renal replacement therapy.
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http://dx.doi.org/10.1016/j.riam.2016.02.004DOI Listing
November 2017

[Bacteraemia and infection of the vascular catheter in the haematology patient: positioning and management based on the Delphi method].

Rev Esp Quimioter 2016 Feb 15;29(1):15-24. Epub 2016 Feb 15.

José Ramón Azanza Perea. Clínica Universidad de Navarra. Navarra; Dirección Avda Pío XII 36., Navarra, Spain.

Objective: Infectious complications are an important cause of morbidity and mortality in haematological patients with febrile neutropenia. The aim of this study was to develop a consensus document of recommendations to optimize the management of febrile neutropenic patients with haematological or vascular catheter infections in areas where there is no solid scientific evidence.

Methods: After reviewing the scientific evidence, a scientific committee composed of experts in haematology and infectious diseases developed a survey with 55 statements. A two- round modified Delphi method was used to achieve consensus.

Results: The online survey was answered by 52 experts in the field of haematology and infectious diseases. After two rounds of evaluation, a consensus was possible in 43 of the 55 statements (78.2%): 40 in agreement and 3 in disagreement. Recommendations are given related to empirical antibiotic treatment of patients with febrile neutropenia, mechanisms of action, toxicity and synergism of antibiotics in this context, modifications of antibiotic treatment in the course of febrile neutropenia, and the management of central vascular catheter infections in the haematological setting.

Conclusions: There is a high degree of agreement among experts on some controversial issues concerning the management of febrile neutropenia and catheter infection in hematologic patients. This agreement has resulted in recommendations that may be useful in clinical practice.
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February 2016

[Liposomal amphotericin B: a unique pharmacokinetic profile. An unfinished story].

Rev Esp Quimioter 2012 Mar;25(1):17-24

José Ramón Azanza Perea, Servicio de Farmacología Clínica, Clínica Universidad de Navarra, Avenida Pío XII s/n - 31008 Pamplona, Spain.

Amphotericin B in its lipid formulation continues to be the reference drug in the treatment of systemic fungal infections despite the time elapse since the development of this compound. The absence of fungal resistance, pharmacokinetics, and the better tolerability profile as compared with the remaining formulations of amphotericin B are sufficient reasons to justify its prominent therapeutic role. The liposome containing liposomal amphotericin B is very stable in relation to the presence of cholesterol and phospholipids are not thermolabile, so that free amphotericin B is almost inexistent (<1%), which explains the reduced incidence of effects related to the drug administration, and a reduction in the incidence of nephrotoxicity (half than that with amphotericin B lipid complex) and that even in some studies at doses of 1 mg/kg has been shown to be negligible. This profile explains the very high plasma drug concentrations and the reduced distribution volume and clearance, with a very prolonged elimination half-life. There are evidences showing that the liposome through amphotericin B is capable of binding to ergosterol present in the fungal membrane and only at this moment would be the antifungal released to exert its pharmacological effects.
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March 2012

Recommendations for the treatment of invasive fungal infection caused by filamentous fungi in the hematological patient.

Rev Esp Quimioter 2011 Dec;24(4):263-70

Servicio de Enfermedades Infecciosas, Hospital Central de la Defensa Gómez Ulla, E-28047 Madrid, Spain.

Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results.
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December 2011

[New therapeutic strategies for multiple myeloma. Efficacy and cost-effectiveness analyses].

Med Clin (Barc) 2008 May;130(16):626-35

Servicio de Farmacología Clínica, Clínica Universitaria de Navarra, Pamplona, Navarra. España.

The objective of the present article is the review of the most important therapeutic innovations in the treatment of multiple myeloma in terms of efficacy and cost-effectiveness. Besides autologous transplant with peripheral-blood stem-cell, thalidomide establishes as one of the most powerful therapeutic tools in induction and maintenance treatment and together with lenalidomide and bortezomib as therapy for relapsing/refractory multiple myeloma. Considering, the last named situation thalidomide can be an adequate therapeutical option in combination with dexamethasone. Under a strictly pharmacoeconomic point of view, lenalidomide and bortezomib seem to be additional alternatives in patients previously treated with thalidomide.
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http://dx.doi.org/10.1157/13120342DOI Listing
May 2008

[Fosfomycin trometamol: multiple-dose regimen for the treatment of lower urinary tract infections].

Enferm Infecc Microbiol Clin 2006 Nov;24(9):546-50

Servicio de Farmacología Clínica, Clínica Universitaria de Navarra. España.

Introduction: A short antibiotic regimen is recommended for the treatment of uncomplicated lower urinary tract infection. Nevertheless, the treatment to follow in other situations is not so clearly defined. When the person affected by lower urinary tract infection is not a young woman, it is recommended to treat at least 7 days, and quinolones or cotrimoxazole are the antibiotics most often used. However, because of the frequency of drug resistance in this type if infection, it is advisable to apply antibiotics with lower rates of resistance, such as fosfomycin trometamol, for longer treatment periods than the often-used single dose.

Methods: Using the data on urinary elimination of fosfomycin after a single dose obtained in a prior study in healthy volunteers, we simulated the urinary concentrations of this antibiotic following administration of two doses. In addition, we calculated the interval of administration required to achieve urinary concentrations greater than 16 mg/L, the critical concentration of sensitivity for Escherichia coli, one of the most commonly implicated microorganisms in these infections.

Results: Fosfomycin concentrations in urine persisted above the defined cut-off for 161 hours after administration of two 3-g doses of fosfomycin trometamol, 72 hours apart. This implied an efficacy time of 66% in a period of 7 days.

Conclusion: From the pharmacokinetic viewpoint, the optimum dosage of fosfomycin trometamol to achieve appropriate urinary concentrations along 7 days is administration of two 3-g doses, 72 hours apart.
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http://dx.doi.org/10.1157/13093873DOI Listing
November 2006