Neurological adverse events to voriconazole: evidence for therapeutic drug monitoring.
BACKGROUND
Voriconazole shows a considerable interpatient variation of serum concentrations.


RESULTS
In an analysis of 28 treatment courses, 6 patients presented with neurological adverse events (hallucination, encephalopathy, and visual disturbance). The hazard ratio per 0.1 mg/mL voriconazole serum level (sVL) increase was 2.27 (95% CI: 1.45-3.56, p <0.001). There was no correlation between sVL and creatinine (r = 0.12, p = 0.114), ALT (r = -0.14, p = 0.072), AST (r = 0.003, p = 0.964), alkaline phosphatase (r = 0.03, p = 0.723).


CONCLUSIONS
Our findings demonstrate that elevated sVL is associated with neurological adverse events, and measurement of its serum concentration could improve voriconazole treatment and safety.
Imhof
Alexander
A
Department of Internal Medicine, University Hospital, Zurich, Switzerland. alexander.imhof@usz.ch
Schaer
Dominik J
DJ
Schanz
Urs
U
Schwarz
Urs
U
D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects* / Q000097:blood; D001247:Asthenia / Q000139:chemically induced; D003072:Cognition Disorders / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D007508:Irritable Mood; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D011743:Pyrimidines / Q000009:adverse effects* / Q000097:blood; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D014230:Triazoles / Q000009:adverse effects* / Q000097:blood; D014786:Vision Disorders / Q000139:chemically induced; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole