摘要
Voriconazole is an azole useful for the prophylaxis and the treatment of aspergillosis and other fungal infections in immunosuppressed subjects, as those found in aplasia after aggressive polychemotherapy treatments, after hematopoietic stem cell, liver or lung transplantation. Its administration in therapeutic doses lead to extremely varied serum levels from patient to patient and even to the same patient. The explanations are varied: nonlinearpharmacokinetics, certain patient-related factors, including genetic polymorphisms in the cytochrome P450 2C19 gene, the kidney and liver function, simultaneous administration with other drugs metabolised by the same cytochrome. It is recommended to maintain the serum concentrations of voriconazole between 1.5 and 4 μg/m L. At lower values its efficacy decreases and at higher values the risk of neurological toxicity increases. Even at these concentrations it is not excluded the possible appearance of a variety of toxic effects, including on the liver, manifested by cholestasis, hepatocytolisis, or their combination. It is recommended to monitor the clinical and laboratory evolution of all patients treated with voriconazole, and of the serum levels of the drug of those who belong to risk groups, even if there is still no consensus on this issue, given the lack of correlation between the serum level and the occurrence of adverse effects in many patients.
Voriconazole is an azole useful for the prophylaxis andthe treatment of aspergillosis and other fungal infectionsin immunosuppressed subjects, as those found in aplasiaafter aggressive polychemotherapy treatments, afterhematopoietic stem cell, liver or lung transplantation.Its administration in therapeutic doses lead to extremelyvaried serum levels from patient to patient and even tothe same patient. The explanations are varied nonlinearpharmacokinetics, certain patient-related factors,including genetic polymorphisms in the cytochrome P4502C19 gene, the kidney and liver function, simultaneousadministration with other drugs metabolised by the samecytochrome. It is recommended to maintain the serumconcentrations of voriconazole between 1.5 and 4 μg/mL.At lower values its efficacy decreases and at highervalues the risk of neurological toxicity increases. Evenat these concentrations it is not excluded the possibleappearance of a variety of toxic effects, including onthe liver, manifested by cholestasis, hepatocytolisis, ortheir combination. It is recommended to monitor theclinical and laboratory evolution of all patients treatedwith voriconazole, and of the serum levels of the drugof those who belong to risk groups, even if there is stillno consensus on this issue, given the lack of correlationbetween the serum level and the occurrence of adverseeffects in many patients.
