Details of Drug Interaction | MecDDI

Drug General Information (ID: DDIO95KL1E)
Drug Name			Mycophenolic acid		Drug Info		Isavuconazonium		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiviral Agents				Azole Antifungals
Structure

Mechanism of Mycophenolic acid-Isavuconazonium Interaction (Severity Level: Moderate)
UGT inhibition Click to Show/Hide Mechanism Graph

Drug Name		Mycophenolic acid				Isavuconazonium
Mechanism		UGT substrate				UGT inhibitor
Key Mechanism Factor 1
		Factor Name		UDP-glucuronosyltransferase				Structure Sequence
		Protein Family		UDP-glycosyltransferase family
		Protein Function		[Isoform 1]: UDP-glucuronosyltransferase (UGT) that catalyzes phase II biotransformation reactions in which lipophilic substrates are conjugated with glucuronic acid to increase the metabolite's water solubility, thereby facilitating excretion into either the urine or bile (PubMed:12181437, PubMed:15472229, PubMed:18004206, PubMed:18004212, PubMed:18719240, PubMed:19830808, PubMed:23288867). Essential for the elimination and detoxification of drugs, xenobiotics and endogenous compounds (PubMed:12181437, PubMed:18004206, PubMed:18004212). Catalyzes the glucuronidation of endogenous estrogen hormones such as estradiol, estrone and estriol (PubMed:15472229, PubMed:18719240, PubMed:23288867). Involved in the glucuronidation of bilirubin, a degradation product occurring in the normal catabolic pathway that breaks down heme in vertebrates (PubMed:17187418, PubMed:18004206, PubMed:19830808). Also catalyzes the glucuronidation the isoflavones genistein, daidzein, glycitein, formononetin, biochanin A and prunetin, which are phytoestrogens with anticancer and cardiovascular properties (PubMed:18052087, PubMed:19545173). Involved in the glucuronidation of the AGTR1 angiotensin receptor antagonist losartan, a drug which can inhibit the effect of angiotensin II (PubMed:18674515). Involved in the biotransformation of 7-ethyl-10-hydroxycamptothecin (SN-38), the pharmacologically active metabolite of the anticancer drug irinotecan (PubMed:12181437, PubMed:18004212, PubMed:20610558). Click to Show/Hide
Mechanism Description		Decreased metabolism of Mycophenolic acid caused by Isavuconazonium mediated inhibition of UGT

Recommended Action
Management		Caution is advised when mycophenolic acid is prescribed with isavuconazonium sulfate. Clinical and laboratory monitoring are recommended following the addition or withdrawal of isavuconazonium sulfate, and the mycophenolic acid dosage adjusted as necessary.

References
1	Product Information. Cresemba (isavuconazonium). Astellas Pharma US, Inc, Deerfield, IL.