Browsing Pathways

Voriconazole is a triazole antifungal agent used to treat invasive fungal infections, generally seen in patients who are immunocompromised. It has an increased affinity to 14-alpha sterol demethylase, and therefore makes it useful against fluconazole-resistant fungal infections. It is taken orally and used to treat esophageal candidiasis, cadidemia, invasive pulmonary aspergillosis, and serious fungal infections caused by Scedosporium apiospermum and Fusarium spp. Voriconazole is effective against all Candida species (including those resistant to other antifungal drugs), Cryptococcus neoformans, Trichosporon beigelii, and Saccharomyces cerevisiae. Voriconazole inhibits and antagonizes the production of ergosterol by inhibiting Lanosterol 14-alpha demethylase. It has a higher affinity for Lanosterol 14-alpha demethylase than other antifungal agents. Lanosterol 14-alpha demethylase is the enzyme that catalyzes the synthesis of 4,4'-dimethyl cholesta-8,14,24-triene-3-beta-ol from lanosterol. With this enzyme inhibited ergosterol synthesis cannot occur which causes a significant low concentration of ergosterol in the fungal cell. Ergosterol is essential in maintaining membrane integrity in fungi. Without ergosterol, the fungus cell cannot synthesize membranes thereby increasing fluidity and preventing growth of new cells. With fungal growth limited, it allows the immune system to destroy the fungal cells.

Vorapaxar also known as Zontivity, is an inhibitor for platelet aggregation used to treat patients with a history of myocardial infarction or peripheral arterial disease to reduce the chance of thrombotic cardiovascular events. Vorapaxar inhibits protease-activated receptor 1 (PAR-1), which is a G protein-coupled receptor that is expressed on the platelet. Inhibition of PAR-1 prevents platelet aggregation and activation. Vorapaxar is administered orally and rapidly absorbs and travels through the bloodstream. It is metabolized to major metabolites M20 and M19 by CYP3A4 and CYP2J2. This is then eliminated primarily through feces and urine. Due to the anticoagulant and antiplatelet nature, herbs and supplements with similar activity should be avoided such as garlic, ginger, bilberry, danshen, piracetam and ginkgo biloba. St.John's Wort should also be avoided as it induces CYP3A metabolism and will reduce the concentration of Vorapaxar. Caution should be exercised with grapefruit products, as coadministration with strong inhibitors should be avoided.

Vonoprazan is a drug that is not metabolized by the human body as determined by current research and biotransformer analysis. Vonoprazan passes through the liver and is then excreted from the body mainly through the kidney.