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Semin Respir Crit Care Med 2015; 36(05): 786-795
DOI: 10.1055/s-0035-1562903
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Voriconazole: How to Use This Antifungal Agent and What to Expect

Anurag N. Malani
1   Department of Internal Medicine, Section of Infectious Diseases, St. Joseph Mercy Hospital, Ann Arbor, Michigan
2   Department of Infection Prevention and Control, St. Joseph Mercy Hospital, Ann Arbor, Michigan
,
Lisa E. Kerr
3   Department of Pharmacy, St. Joseph Mercy Hospital, Ann Arbor, Michigan
,
Carol A. Kauffman
4   Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, Michigan
› Author Affiliations
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Publication History

Publication Date:
23 September 2015 (online)

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Abstract

Voriconazole is an important agent in the antifungal armamentarium. It is the treatment of choice for invasive aspergillosis, other hyaline molds, and many brown-black molds. It is also effective for infections caused by Candida species, including those that are fluconazole resistant, and for infections caused by the endemic mycoses, including those that occur in the central nervous system. It has the advantage of being available in both an intravenous and an oral formulation that is well absorbed. Drawbacks to the use of voriconazole are that it has unpredictable, nonlinear pharmacokinetics with extensive interpatient and intrapatient variation in serum levels. Some of the adverse effects seen with voriconazole are related to high serum concentrations, and, as a result, therapeutic drug monitoring is essential when using this agent. Drug–drug interactions are common, and possible interactions must be sought before voriconazole is prescribed. With prolonged use, newly described adverse effects, including periostitis, alopecia, and development of skin cancers, have been noted.

Keywords

voriconazole - aspergillosis - candidiasis - drug–drug interactions - therapeutic drug monitoring - periostitis - alopecia
 

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