Voriconazole - Revision history

Aidan: /* Therapeutic Drug Monitoring */

2025-07-23T16:15:44Z

Therapeutic Drug Monitoring

← Older revision		Revision as of 16:15, 23 July 2025
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	===Therapeutic Drug Monitoring===		===Therapeutic Drug Monitoring===

	*Measure trough within 7 days of starting, and at regular intervals ~~or following dose adjustment~~		*Measure trough within 5 to 7 days of starting or following dose adjustment, and at regular intervals
	*Target trough > 1 mg/L for prophylaxis and treatment		*Target trough > 1 mg/L for prophylaxis and treatment

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	\|4.1 to 5.5\|\|Decrease dose by 50 mg and recheck trough on day 5 of new regimen		\|4.1 to 5.5\|\|Decrease dose by 50 mg and recheck trough on day 5 of new regimen
	\|-		\|-
	\|5.6 to 7.9\|\|Hold dose. Follow ~~daily~~ trough levels, then restart when trough is ≤2.5 at a dose decreased by 100 mg. Recheck trough on day 5 of new regimen.		\|5.6 to 7.9\|\|Hold dose. Follow trough levels every 2 days, then restart when trough is ≤2.5 at a dose decreased by 100 mg. Recheck trough on day 5 of new regimen.
	\|-		\|-
	\|≥8.0\|\|Hold dose. Follow ~~daily~~ trough levels, then restart when trough is ≤2.5 at a dose decreased by 50%. Recheck trough level on day 5 of new regimen.		\|≥8.0\|\|Hold dose. Follow trough levels every 2 days, then restart when trough is ≤2.5 at a dose decreased by 50%. Recheck trough level on day 5 of new regimen.
	\|}		\|}

Aidan: added EUCAST aspergillus interpretations

2024-10-22T13:10:32Z

added EUCAST aspergillus interpretations

← Older revision		Revision as of 13:10, 22 October 2024
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	\|[[Cryptococcus neoformans]]		\|[[Cryptococcus neoformans]]
	\|0.25		\|0.25
	\| colspan="8" rowspan="6" \|		\| colspan="8" rowspan="2" \|
	\|-		\|-
	\|[[Cryptococcus gattii]]		\|[[Cryptococcus gattii]]
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	\|[[Aspergillus flavus]]		\|[[Aspergillus flavus]]
	\|2		\|2
			\|—
			\| colspan="2" rowspan="5" \|
			\|—
			\| colspan="4" rowspan="5" \|
	\|-		\|-
	\|[[Aspergillus fumigatus]]		\|[[Aspergillus fumigatus]]
	\|1		\|1
			\|≤1
			\|>1
			\|-
			\|[[Aspergillus niger]]
			\|1
			\|≤1
			\|>1
	\|-		\|-
	\|[[Aspergillus niger]]		\|[[Aspergillus niger]]
	\|2		\|2
			\|—
			\|—
	\|-		\|-
	\|[[Aspergillus terreus]]		\|[[Aspergillus terreus]]
	\|2		\|2
			\|—
			\|—
	\|}		\|}

Aidan: /* Drug-Drug Interactions */

2024-09-23T14:09:02Z

Drug-Drug Interactions

← Older revision		Revision as of 14:09, 23 September 2024
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	===Drug-Drug Interactions===		===Drug-Drug Interactions===

	*Voriconazole is metabolised by CYP450 enzymes		*Voriconazole is metabolised by [[Metabolized by::CYP450]] enzymes
	*Voriconazole also inhibits CYP3A4 and CYP2C9		*Voriconazole also inhibits [[Inhibits::CYP3A4]] and [[Inhibits::CYP2C9]]

	{\| class="wikitable"		{\| class="wikitable"

Aidan at 17:47, 19 September 2024

2024-09-19T17:47:57Z

← Older revision		Revision as of 17:47, 19 September 2024
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	**[[Adverse drug reaction::Photosensitivity]]		**[[Adverse drug reaction::Photosensitivity]]
	*[[Adverse drug reaction::Hepatotoxicity]][[CiteRef::mihăilă2015vo]]		*[[Adverse drug reaction::Hepatotoxicity]][[CiteRef::mihăilă2015vo]]
	**Risk factors include higher trough (though can occur at any level), other hepatotoxic medications (and specifically [[tigecycline]] and [[TMP-SMX]]), and septic shock<ref>Taotao Wang, Liyan Miao, Hua Shao, Xiaohua Wei, Miao Yan, Xiaocong Zuo, Jun Zhang, Xin Hai, Guangjun Fan, Wei Wang, Linlin Hu, Jian Zhou, Yichang Zhao, Yueliang Xie, Jingjing Wang, Sixun Guo, Liu Jin, Hao Li, Hui Liu, Quanfang Wang, Jiaojiao Chen, Sihan Li, Yalin Dong. Voriconazole Therapeutic Drug Monitoring and Hepatotoxicity in Critically Ill Patients: ~~A Nationwide Multicenter Retrospective Study. ''International Journal of Antimicrobial Agents'', 2022, Page 106692. doi~~: ~~https://doi.org/10.1016/j.ijantimicag.2022.106692</ref>~~		**Risk factors include higher trough (though can occur at any level), other hepatotoxic medications (and specifically [[tigecycline]] and [[TMP-SMX]]), and septic shock[[CiteRef::wang2022vo]]
	**In critically ill patients, mostly occurs within 7 days of starting		**In critically ill patients, mostly occurs within 7 days of starting
	**Primarily cholestasis, but can be hepatocellular damage or mixed		**Primarily cholestasis, but can be hepatocellular damage or mixed

Aidan: /* Adverse Drug Reactions */

2022-11-13T14:07:36Z

Adverse Drug Reactions

← Older revision		Revision as of 14:07, 13 November 2022
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	**[[Adverse drug reaction::Photosensitivity]]		**[[Adverse drug reaction::Photosensitivity]]
	*[[Adverse drug reaction::Hepatotoxicity]][[CiteRef::mihăilă2015vo]]		*[[Adverse drug reaction::Hepatotoxicity]][[CiteRef::mihăilă2015vo]]
			**Risk factors include higher trough (though can occur at any level), other hepatotoxic medications (and specifically [[tigecycline]] and [[TMP-SMX]]), and septic shock<ref>Taotao Wang, Liyan Miao, Hua Shao, Xiaohua Wei, Miao Yan, Xiaocong Zuo, Jun Zhang, Xin Hai, Guangjun Fan, Wei Wang, Linlin Hu, Jian Zhou, Yichang Zhao, Yueliang Xie, Jingjing Wang, Sixun Guo, Liu Jin, Hao Li, Hui Liu, Quanfang Wang, Jiaojiao Chen, Sihan Li, Yalin Dong. Voriconazole Therapeutic Drug Monitoring and Hepatotoxicity in Critically Ill Patients: A Nationwide Multicenter Retrospective Study. ''International Journal of Antimicrobial Agents'', 2022, Page 106692. doi: https://doi.org/10.1016/j.ijantimicag.2022.106692</ref>
	**Can occur at any trough level, but more commonly at higher levels
			**In critically ill patients, mostly occurs within 7 days of starting
	**Primarily cholestasis, but can be hepatocellular damage or mixed		**Primarily cholestasis, but can be hepatocellular damage or mixed
	**Resolves with discontinuation, but can take 1 to 3 months		**Resolves with discontinuation, but can take 1 to 3 months

Aidan: /* Safety */

2022-03-30T13:22:23Z

Safety

← Older revision		Revision as of 13:22, 30 March 2022
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	**Primarily cholestasis, but can be hepatocellular damage or mixed		**Primarily cholestasis, but can be hepatocellular damage or mixed
	**Resolves with discontinuation, but can take 1 to 3 months		**Resolves with discontinuation, but can take 1 to 3 months
			**See also [https://www.ncbi.nlm.nih.gov/books/NBK547891/ LiverTox]
	*[[Adverse drug reaction::QTc prolongation]]		*[[Adverse drug reaction::QTc prolongation]]
	*Headache, nausea and vomiting, diarrhea, abdominal pain		*Headache, nausea and vomiting, diarrhea, abdominal pain

Aidan at 23:17, 12 March 2022

2022-03-12T23:17:39Z

← Older revision		Revision as of 23:17, 12 March 2022
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	===Spectrum of Activity===		===Spectrum of Activity===

	*Active against [[Aspergillus]] (including [[Aspergillus terreus]]), [[Scedosporium ~~species~~]], [[Fusarium ~~species~~]], and [[Candida ~~species~~]]		*Active against [[Aspergillus]] (including [[Aspergillus terreus]]), [[Scedosporium]], [[Fusarium]], and [[Candida]]
	*Possibly active against [[Cryptococcus ~~species~~]], [[Blastomyces dermatitidis]], [[Coccidioides immitis]], and [[Histoplasma capsulatum]]		*Possibly active against [[Cryptococcus]], [[Blastomyces dermatitidis]], [[Coccidioides immitis]], and [[Histoplasma capsulatum]]
	*Less active against [[Sporothrix schenckii]]		*Less active against [[Sporothrix schenckii]]

Aidan: /* Liver Dysfunction */

2022-02-14T15:53:06Z

Liver Dysfunction

← Older revision		Revision as of 15:53, 14 February 2022
Line 143:		Line 143:

	* Weekly liver enzymes for first month, then monthly thereafter		* Weekly liver enzymes for first month, then monthly thereafter

			=== Renal Dysfunction ===

			* No dosage adjustment necessary, though for the IV formulation there is a risk of accumulation of sulfobutylether-beta-cyclodextrin (SBECD), which has been associated with renal injury in animal models

	=== Liver Dysfunction ===		=== Liver Dysfunction ===

Aidan at 20:03, 6 January 2022

2022-01-06T20:03:51Z

← Older revision		Revision as of 20:03, 6 January 2022
Line 143:		Line 143:

	* Weekly liver enzymes for first month, then monthly thereafter		* Weekly liver enzymes for first month, then monthly thereafter

			=== Liver Dysfunction ===

			* For Child-Pugh A and B, consider reducing the maintenance dose to half the usual dose, while keeping the same loading dose

	==Safety==		==Safety==

Aidan: /* Safety */

2021-06-17T15:06:11Z

Safety

← Older revision		Revision as of 15:06, 17 June 2021
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	\|≥8.0\|\|Hold dose. Follow daily trough levels, then restart when trough is ≤2.5 at a dose decreased by 50%. Recheck trough level on day 5 of new regimen.		\|≥8.0\|\|Hold dose. Follow daily trough levels, then restart when trough is ≤2.5 at a dose decreased by 50%. Recheck trough level on day 5 of new regimen.
	\|}		\|}

			=== Monitoring ===

			* Weekly liver enzymes for first month, then monthly thereafter

	==Safety==		==Safety==