E-drug: Ketoconazole (cont)
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Dear colleagues,
The comments by WHO EDM have been very helpful - I have
already had some exchange of E-mails with interested colleagues,
but it seems that the manufacturer has crawled back from his
original offer to severely restrict the indications, and that this has
been accepted by the CPMP (EU). But it seems that they kept the
licence but stopped marketing. Their own itraconazole did not offer
clear advantages (in contrast to fluconazole).
When looking back at the comparative pharmacological properties
of ketoconazole and fluconazole - especially their lipophility - it
seems highly probable that ketoconazole is just as effective in
meningeal cryptococcosis, but it has never been tried, and probably
never will because of its toxicity. Retrospectively it might have been
a good and cheap choice, being the lesser of two evils. But we will
probably never know.
It is good to know that fluconazole has now replaced ketoconazole
as an example in the WHO EDL. A commendable decision.
Dr.L.Offerhaus
Koedijklaan 1a, NL-1406KW Bussum, The Netherlands
Phone: +31-35-6923288. Fax: +31-35-6923290
E-mail: LO@EURONET.NL CompuServe: 71530,15
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