title: Adverse effects of voriconazole: Over a decade of use.
abstract: Voriconazole use has increased since the drug's introduction in 2002, and new and unique adverse effects are emerging as patients undergo prolonged therapy. Most concerning is the increased risk of cutaneous malignancies, primarily squamous cell carcinoma (SCC); this risk is duration dependent and the associated malignancies tend to be more aggressive and multifocal. Voriconazole is also associated with phototoxicity (which may be a precursor to malignancy), periostitis, hallucinations and encephalopathy, peripheral neuropathy, alopecia, nail changes, hyponatremia, and other adverse effects. Some toxicities (neuropsychiatric and gastrointestinal including hepatic) are seen in clear association with supratherapeutic serum voriconazole levels; thus, careful monitoring of voriconazole levels is a critical component of safe drug use. Guidelines for screening for adverse effects after long-term voriconazole use may be beneficial and need to be established.
authors: Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI, USA. mlevine@med.wayne.edu.
authors: Miriam T
authors: MT
authors: Levine
authors: Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI, USA. pchandrasekar@med.wayne.edu.
authors: Pranatharthi H
authors: PH
authors: Chandrasekar
mesh_terms: D000328:Adult; D000505:Alopecia / Q000139:chemically induced; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D006258:Head and Neck Neoplasms / Q000139:chemically induced; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy; D008297:Male; D009260:Nail Diseases / Q000139:chemically induced; D009422:Nervous System Diseases / Q000139:chemically induced; D010522:Periostitis / Q000139:chemically induced; D012878:Skin Neoplasms / Q000139:chemically induced; D000077195:Squamous Cell Carcinoma of Head and Neck; D065819:Voriconazole / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: cutaneous malignancy; hyponatremia; neuropathy; periostitis; voriconazole