title: Voriconazole in clinical practice.
abstract: Invasive fungal diseases are associated with significant morbidity and mortality in immunocompromized patients. Voriconazole is the first line treatment of invasive aspergillosis, and has been successfully used in other invasive fungal infections, such as candidiasis, fusariosis or  scedosporidiosis. Voriconazole has non-linear pharmacokinetics and undergoes extensive hepatic metabolism by the cytochrome P450 system that depends on age, genetic factors, and interactions with other drugs. Thus, significant interpatient variability is observed after administration of the  same dose. Additionally, the therapeutic window is narrow, with high risk of side effects at serum levels 3-5 times higher than the minimal threshold for efficacy. Therefore, the knowledge of pharmacological properties, metabolism, interactions, dosage indications in various populations  and side effects is crucial. Therapeutic drug monitoring can help maximize the efficacy and minimize the risk of toxicity. Pharmacological, mycological and clinical aspects of the treatment with voriconazole are summarized in order to optimize its use in daily clinical practice.
authors.affiliation: Division of Infectious Diseases, University of Genoa and San Martino University Hospital, Genoa, Italy. m.mikulska@unige.it
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Mikulska
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: de Rosa
authors.forename: Corrado
authors.initials: C
authors.lastname: Girmenia
authors.forename: Alessandra
authors.initials: A
authors.lastname: Micozzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D058888:14-alpha Demethylase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D025141:Drug Resistance, Fungal; D019317:Evidence-Based Medicine; D005658:Fungi / Q000187:drug effects; D006801:Humans; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D058888:14-alpha Demethylase Inhibitors; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole