Voriconazole‐induced pseudoporphyria

Tolland, J.P.; McKeown, Pascal; Corbett, James R.

doi:10.1111/j.1600-0781.2007.00263.x

Cited by 61 publications

(41 citation statements)

References 4 publications

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“…78 Pseudoporphyria, toxic epidermal necrolysis, and multifocal facial squamous cell carcinomas have also been reported. [79][80][81] Use of sunscreen should be advised, and appropriate guidance for sun exposure avoidance should be given in chronically treated patients. QT-prolongation and torsades de pointes should be considered in patients with predisposing factors.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…58,85,[87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] Triazoles have numerous clinically significant drug interactions, the list is constantly expanding and the majority of those currently identified are presented in Table 2 17,85,86,[91][92][93][94][95][96][97][98][99][100][101][102] and Table 3. [52][53][54][55]57,62,[75][76][77][78][79][80][81][82]86 Most of these interactions arise from competitive inhibition of liver oxidative metabolism via rapid reversible binding to …”

Section: Drug Interactionsmentioning

confidence: 99%

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Pharmacotherapy of Invasive Fungal Infections with Voriconazole

Ghebremedhin

2011

Clinical Medicine Reviews in Therapeutics

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Voriconazole, a second-generation and broad-spectrum triazole derivative of fluconazole, inhibits the cytochrome P450 (CYP)-dependent enzyme 14-α-sterol demethylase, which is a pivotal step in cell membrane ergosterol synthesis in fungi. CYP2C19, CYP3A4, flavin-containing monooxygenase (FMO), and to a lesser extent CYP2C9 contribute to the oxidative metabolism of voriconazole by human liver microsomes. Clinical trials have demonstrated the safety and efficacy of voriconazole for prophylaxis and treatment in candidiasis, invasive aspergillosis, and in invasive fungal infections (IFIs) caused by a variety of non-Aspergillus molds, such as Fusarium or Scedosporium spp., and was generally well tolerated as primary therapy in adults and children. The availability of both parenteral and oral formulations and the nearly complete absorption (bioavailability of 96% for adults, ca. 40% in children) of the drug after oral administration provide for ease of use and potential cost savings, and ensure that the therapeutic plasma concentrations are maintained when switching from intravenous to oral regimes. It exhibits nonlinear pharmacokinetics in healthy controls and patients at high risk of IFIs, but considerable intra-and interpatient pharmacokinetic variability has raised the question of therapeutic drug monitoring. Most common adverse events are visual disturbances and elevated transaminase levels. The emergence of resistance towards voriconazole has been rarely reported.

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Section: Adverse Eventsmentioning

confidence: 99%

Section: Drug Interactionsmentioning

confidence: 99%

Pharmacotherapy of Invasive Fungal Infections with Voriconazole

Ghebremedhin

2011

Clinical Medicine Reviews in Therapeutics

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“…It manifests most frequently as sunburn-like erythema on exposed skin surfaces [11]. Other dermatologic complications include exfoliative dermatitis, pseudoporphyria [12,13], photoaging with multiple lentigines and premature dermatoheliosis [14]. In general, these reactions are reversible upon discontinuation of the drug.…”

Section: Introductionmentioning

confidence: 98%

Long-Term Voriconazole and Skin Cancer: Is There Cause for Concern?

Clancy

Nguyen

2011

Curr Infect Dis Rep

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Skin toxicity due to voriconazole is well recognized. Recently, several series have reported skin cancer, particularly cutaneous squamous cell carcinoma (C-SCC), following photosensitivity reactions among patients receiving long-term voriconazole (>12 months). Almost all patients were immunosuppressed, including stem cell and solid organ transplant recipients. A case-control study of lung transplant recipients identified long-term voriconazole (median cumulative dose: 76 grams) and residence in areas of strong sun exposure as independent risk factors for C-SCC. The mechanism(s) by which voriconazole may predispose to skin cancer is not clear. Moreover, the relative contribution of voriconazole and other factors such as immunosuppression, ultraviolet exposure, advanced age and skin type is unknown. Until further data are available, voriconazole should be used carefully for durations >6-9 months, particularly among patients with risk factors for skin cancer. In patients requiring prolonged voriconazole, diligent skin examinations, avoidance of excess sunlight, and liberal use of UV protectants are advisable.

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“…Pseudoporphyria with chronic skin fragility and flaccid bullae on noninflamed sun-exposed skin, occasionally with later milia formation, mimicking porphyria cutanea tarda on clinical and histopathology (bullae formation below the lamina densa), was described initially for nalidixic acid, furosemide, and naproxen, predominantly in children [14,39] and, more recently, for ciprofloxacin [40], celecoxib [41,42], voriconazole [28,43], and imatinib [44]. This may represent a typical phototoxic reaction where the drug, as the chromophore, has a similar mechanism of inducing the phototoxic reaction (singlet oxygen) as the uroporphyrin in the hereditary disease [14,39].…”

Section: Pseudoporphyriamentioning

confidence: 99%

“…Another antifungal, still from a different chemical group, voriconazole, has recently been reported to cause severe photosensitivity [7] and was considered responsible for skin cancer [16,28,43].…”

Section: Core Messagementioning

confidence: 99%

Phototoxic and Photoallergic Reactions

Gonçalo

2010

Contact Dermatitis

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Voriconazole‐induced pseudoporphyria

Cited by 61 publications

References 4 publications

Pharmacotherapy of Invasive Fungal Infections with Voriconazole

Pharmacotherapy of Invasive Fungal Infections with Voriconazole

Long-Term Voriconazole and Skin Cancer: Is There Cause for Concern?

Phototoxic and Photoallergic Reactions

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