[Not Available].

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Infectious Diseases

Context:

• Voriconazole is a critical antifungal agent for immunocompromised patients, effective against endemic fungi, Candida, and Aspergillus species.
• Its efficacy and toxicity are linked to plasma trough concentrations, with sub-therapeutic levels (<1-2 μg/mL) associated with treatment failure and concentrations above 5 μg/mL linked to adverse effects.
• Specific populations like children, patients with renal or hepatic insufficiency, cystic fibrosis patients, and those on interacting medications require careful consideration.

Purpose:

• To review the current evidence on voriconazole therapeutic drug monitoring (TDM).
• To highlight the relationship between voriconazole trough concentrations, clinical outcomes (efficacy and toxicity), and special populations.
• To assess the recommendation for TDM in voriconazole therapy.

Summary:

• Voriconazole TDM is suggested due to the correlation between plasma concentrations and patient outcomes.
• Therapeutic ranges are generally considered to be 1-2 μg/mL for efficacy and below 5 μg/mL to avoid toxicity.
• Special populations and drug interactions necessitate individualized dosing strategies.
• Prospective controlled studies are required to validate TDM and pharmacokinetic-based dosing methods.

Impact:

• Optimizing voriconazole dosing through TDM can improve treatment success rates in vulnerable patient groups.
• Minimizing voriconazole-associated neurotoxicity and hepatotoxicity enhances patient safety and quality of life.
• Establishing validated pharmacokinetic-based dosing strategies will enable personalized voriconazole therapy.