Incidence of voriconazole hepatotoxicity during intravenous and oral treatment for invasive fungal infections.
OBJECTIVE
Absorption of oral voriconazole is good and in contrast to the intravenous (iv) formulation it can be given in patients with renal insufficiency. Furthermore, the acquisition costs are significantly lower. The aim of this study was to compare the incidence of hepatotoxicity in patients treated with the oral formulation of voriconazole with that in patients treated with the iv formulation.


METHODS
This was a retrospective observational study. A total of 35 patients with haematological disease and an invasive fungal infection were treated with oral voriconazole during the entire regimen. We compared the incidence of hepatotoxicity with that in 11 patients treated intravenously during the first week.


RESULTS
The incidence of increased liver enzymes was comparable between both groups. Voriconazole was discontinued in two patients in the oral group and one patient in the iv group because of hepatotoxicity. The incidence of liver enzyme elevations in the entire study cohort of 46 patients was higher than that previously reported in a comparable study population (P < 0.001). However, clinically significant hepatotoxicity was infrequently observed (3/46 or 6.5%).


CONCLUSIONS
In 35 patients with invasive fungal infections we instituted oral voriconazole therapy from day 1 and found an incidence of hepatotoxicity comparable to 11 controls treated intravenously.
Department of Internal Medicine, MCRZ, Rotterdam, The Netherlands.
Jan G
JG
den Hollander
Cornelis
C
van Arkel
Bart J
BJ
Rijnders
Pieternella J
PJ
Lugtenburg
Siem
S
de Marie
Mark-David
MD
Levin
D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D007275:Injections, Intravenous; D008099:Liver / Q000187:drug effects*; D008111:Liver Function Tests; D009181:Mycoses / Q000188:drug therapy*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole