Voriconazole: Difference between revisions

Revision as of 01:41, 21 November 2019

Therapeutic Drug Monitoring

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

Trough (mcg/mL)	Recommendation
0.0 to 0.6	Increase dose by 100 mg and recheck trough on day 5 of new regimen
0.7 to 0.9	Increase dose by 50 mg and recheck trough on day 5 of new regimen
1.0 to 4.0	At target, no dose adjustment needed
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.
≥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.

Adverse Effects

Visual
- Floaters etc that may improve with time
- Visual hallucinations
Hepatotoxicity
QTc prolongation

References

^ Romeo-Gabriel Mihăilă. Voriconazole and the liver. World Journal of Hepatology. 2015;7(13):1828. doi:10.4254/wjh.v7.i14.1828.
^ 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 multi-centre retrospective study. International Journal of Antimicrobial Agents. 2022;60(5-6):106692. doi:10.1016/j.ijantimicag.2022.106692.

@@ Line 1: / Line 1: @@
+== Therapeutic Drug Monitoring ==
-== Dosing ==
+* Measure trough within 7 days of starting, and at regular intervals or following dose adjustment
+* Target trough > 1 mg/L for prophylaxis and treatment
 {| class="wikitable"
-! Trough (mcg/mL)
+! Trough (mcg/mL) !! Recommendation
-! Recommendation
 |-
+| 0.0 to 0.6      || Increase dose by 100 mg and recheck trough on day 5 of new regimen
-| 0.0 to 0.6
-| Increase dose by 100 mg and recheck trough on day 5 of new regimen
 |-
+| 0.7 to 0.9      || Increase dose by 50 mg and recheck trough on day 5 of new regimen
-| 0.7 to 0.9
-| Increase dose by 50 mg and recheck trough on day 5 of new regimen
 |-
-| 1.0 to 4.0
+| 1.0 to 4.0      || At target, no dose adjustment needed
-| At target, no dose adjustment needed
 |-
+| 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 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.
 |-
+| ≥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.
 |}
 == Adverse Effects ==
 * Visual
 ** Floaters etc that may improve with time
@@ Line 33: / Line 27: @@
 == Further Reading ==
 * [https://doi.org/10.1093/ofid/ofv133.527 Voriconazole Dose Modification Guideline to Optimize Therapeutic Levels in Patients With Hematologic Malignancies]. ''Open Forum Infect Dis''. 2015(2)S1:810.