Modulação de Transportadores renais pelo fluconazol e possível impacto na farmacocinética da vancomicina: Implicações para monitoramento terapêutico

Vancomycin and fluconazole are frequently coadministered in hospitalized patients with mixed or suspected fungal–bacterial infections. Although traditionally considered pharmacokinetically independent, emerging evidence suggests that active tubular secretion contributes to vancomycin renal clearance and that azole antifungals may inhibit renal drug transporters involved in this process. In hospital practice, variability in vancomycin exposure and nephrotoxicity during combined antibacterial–antifungal therapy highlights the need to explore non-classical interaction mechanisms. We describe the physiological and pharmacokinetic rationale supporting a transporter-mediated interaction hypothesis, illustrated through a conceptual model and a synthesis of relevant renal transporters. Recognition of this mechanism may improve interpretation of therapeutic drug monitoring and prevention of renal toxicity in vulnerable patients receiving combination therapy.