Effect of antifungal triazoles on vinca alkaloid neurotoxicity in pediatric patients: A retrospective case series analysis and literature review

To describe clinical manifestations, toxicities, and document measures for the management of neurotoxicity of vinca alkaloids (VAs) in pediatric cases. And discuss the difference between VAs monotherapy and combination of triazoles. A retrospective and descriptive analysis of adverse drug interaction (ADR) cases, which reported to the National Center for ADR monitoring from Peking University People’s Hospital from January 2010 to December 2023, was performed. We also herein present a review of the literature on neurotoxicity caused by VAs. One hundred twenty-three patients were included. Median age was 4 years (0.1–18 years) with 86 (70.7%) having a diagnosis of acute lymphoblastic leukemia. The median number of VAs doses administered after which the neurotoxicity occurred was 3 doses (1–12 doses). The median time to clinical manifestations of adverse events was 21 days (1–140 days). The most common neuropathic toxicity is autonomic neuropathy, with paralytic ileus accounting for the highest proportion. More patients experienced severe neurotoxicity when treated with the combination of triazoles and VAs than with VAs monotherapy. In clinical practice, doctors and clinical pharmacists should pay attention to this adverse drug interaction. It is recommended to monitor for signs of neurotoxicity and consider the use of alternative antifungal agents in patients receiving VAs chemotherapy, in order to mitigate the occurrence of this adverse drug interaction.