Voriconazole: Difference between revisions

Revision as of 21:41, 20 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.

@@ 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.