title: Voriconazole concentration monitoring at an academic medical center.
abstract: OBJECTIVE
  Results of a study of the relationship among voriconazole dosages, serum concentrations, adverse effects, and clinical outcomes are presented.
  
  
  METHODS
  A retrospective chart review was conducted that included all patients who had at least one voriconazole concentration drawn between July 1, 2009, and August 15, 2014, at a single academic medical center. The primary outcome was the proportion of patients with initial voriconazole concentrations in the target range.
  
  
  RESULTS
  Forty-seven of 88 patients (53%) had an initial voriconazole concentration within the target range, 27% (24 of 88) of patients had a concentration above the range, and 19% (17 of 88) had a concentration below the range. Sixty-seven percent of patients with above-target concentrations had adverse effects. Voriconazole was discontinued in 9% of patients, and dosages were reduced in 11% of patients because of adverse effects. Voriconazole for treatment versus prophylaxis was analyzed in a subgroup, as was obesity and nonobesity. Twenty-four percent of patients died during their hospital admission, and 14% were not discharged on voriconazole therapy. The within-target group had the highest proportion of patients discharged on voriconazole and the lowest proportion of deaths.
  
  
  CONCLUSIONS
  A retrospective study in one institution revealed that the first measured voriconazole concentration was within the target range in 53% of patients and that dosage was modified in only 51% of patients whose concentration was outside of that range. The majority of patients with above-target concentrations had an adverse effect, and this result was particularly common in patients with a body mass index of ≥35 kg/m(2).
authors.affiliation: Wingate University School of Pharmacy, Wingate, NC jamie.sebaaly@gmail.com.
authors.forename: Jamielynn C
authors.initials: JC
authors.lastname: Sebaaly
authors.affiliation: Infectious Diseases, Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC.
authors.forename: Shawn H
authors.initials: SH
authors.lastname: MacVane
authors.affiliation: Medical/Surgical ICU, Digestive Diseases, Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC.
authors.forename: Tanna B
authors.initials: TB
authors.lastname: Hassig
mesh_terms: D000046:Academic Medical Centers / Q000379:methods*; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000097:blood*; D001927:Brain Diseases / Q000097:blood / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood; D012189:Retrospective Studies; D065819:Voriconazole / Q000009:adverse effects / Q000097:blood*
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole