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Breakthrough Candida infections in patients receiving voriconazole
Lana Gerzenshtein1, Shilpa M Patel, Kimberly K Scarsi
1Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL, USA. lgerzens@nmh.org
The Annals of Pharmacotherapy
|May 26, 2005
Summary
Breakthrough Candida infections occurred in two patients on voriconazole, potentially due to drug interactions with phenytoin and efavirenz. Monitoring voriconazole levels may ensure treatment efficacy.
Area of Science:
- Mycology
- Pharmacology
- Infectious Diseases
Background:
- Voriconazole is a broad-spectrum triazole antifungal agent widely used for invasive fungal infections.
- Drug interactions are a known concern with voriconazole, impacting its efficacy and safety.
- Breakthrough fungal infections can occur despite appropriate antifungal therapy.
Observation:
- Two cases of breakthrough Candida infections (oral and esophageal candidiasis) are described in patients receiving voriconazole.
- One patient with systemic lupus erythematosus received voriconazole with phenytoin; the other with HIV received voriconazole with efavirenz and other antiretrovirals.
- Dose adjustments of voriconazole led to the resolution of breakthrough candidiasis in both instances.
Findings:
- Drug interactions, particularly with phenytoin and efavirenz, are suspected contributors to breakthrough Candida infections.
- Voriconazole is metabolized by and inhibits CYP2C19, CYP2C9, and CYP3A4 enzymes, leading to potential interactions.
- The Naranjo probability scale indicated probable causality for these adverse events.
Implications:
- Clinicians should consider potential drug interactions when prescribing voriconazole, especially in patients on concomitant medications.
- Monitoring voriconazole serum concentrations may be beneficial to ensure therapeutic efficacy in cases of suspected drug interactions.
- Further systematic evaluation is warranted to confirm the role of drug interactions and monitoring in managing voriconazole therapy.