ABSTRACT
Over a course of 7 months, four patients developed vestibulotoxicity after treatment with intravenous tobramycin. Since vestibulotoxicity is a serious adverse effect which can be irreversible, an investigation was undertaken to determine if there was a cause for the toxicity and whether the quality of care had been inadequate. In this period, 26 patients with cystic fibrosis were treated with tobramycin according to valid guidelines, of which four experienced acute dizziness which disrupted their daily activities. Two patients experienced irreversible bilateral vestibular hypofunction and two unilateral loss of the right labyrinth, with decreasing dizziness over time. No apparent cause for the vestibulotoxicity was found in these four patients and the simultaneous occurrence was not due to a lack in quality of care. Symptoms of dizziness and balance disorders should be recognised by patients and caretakers at an early stage so additional diagnostics can be done to prevent further deterioration.
Subject(s)
Cystic Fibrosis , Tobramycin , Cystic Fibrosis/chemically induced , Humans , Retrospective Studies , Tobramycin/adverse effectsABSTRACT
In this case report the potential drug-drug interaction between cytochrome P450 (CYP) 3A4 substrates tezacaftor-ivacaftor and CYP3A4/5 inhibitor clofazimine is investigated in a patient with cystic fibrosis. Exposure to tezacaftor, ivacaftor and its metabolites was assessed by determination of the area under the plasma concentration versus time curve (AUC0-24 h for tezacaftor and AUC0-12 h for ivacaftor and its metabolite) before start of clofazimine and 8 and 115 days after start of clofazimine. The AUC-ratio at day 115 and pre-start was 1.09, 1.45 and 0.747 for ivacaftor, hydroxymethyl ivacaftor and tezacaftor, respectively. This case suggests that clofazimine exhibits no clinically relevant increase in exposure to tezacaftor and ivacaftor.
