Voriconazole: A New Triazole Antifungal Agent

Abstract

Voriconazole is a second-generation azole antifungal agent that shows excellent in vitro activity against a wide variety of yeasts and molds. It can be given by either the intravenous or the oral route; the oral formulation has excellent bioavailability. The side effect profile of voriconazole is unique in that non-sight-threatening, transient visual disturbances occur in approximately 30% of patients given the drug. Rash (which can manifest as photosensitivity) and hepatitis also occur. The potential for drug-drug interactions is high and requires that careful attention be given to dosage regimens and monitoring of serum levels and effects of interacting drugs. Voriconazole has been approved for the treatment of invasive aspergillosis and refractory infections with Pseudallescheria/Scedosporium and Fusarium species, and it will likely become the drug of choice for treatment of serious infections with those filamentous fungi.

Plasma Voriconazole Estimation by HPLC

“…These clinical conditions may contribute to an altered therapeutic efficacy of voriconazole. Genetic variants of the metabolizing enzyme i.e CYP2C19 have also been reported to influence voriconazole metabolism [24] suggesting a large inter-individual variability. Our data also shows high variability in voriconazole level ranging from sub-therapeutic i.e.…”

Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: A multicenter trial in Japan

“…The incidence rate of adverse events was still significantly lower in MCFG group even with exclusion of visual events, which are unique to VRCZ. VRCZ is metabolized via the cytochrome P450 (CYP) 2C19 isozyme in liver 21 and the CYP2C19 mutant type is generally found in 60% -70% of Asian populations including Japanese, 22 which indicates that these poor metabolizers of VRCZ are likely to have more serious liver dysfunction. Our current data showed significantly more occurrence of liver dysfunction in the VRCZ than MCFG group.…”

Has the era of individualised medicine arrived for antifungals? A review of antifungal pharmacogenomics

“…Voriconazole is a triazole antifungal, available as i.v. and oral formulations, with excellent oral bioavailability 61 and highly variable nonlinear pharmacokinetics. [62][63][64] Excretion of voriconazole occurs predominantly via metabolites in the urine, with limited faecal excretion.…”