Decrease of voriconazole trough levels during therapy with enteral nutrition: a case report

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Critical Care Medicine

Background:

• Voriconazole (VRCZ) is a crucial antifungal agent for chronic pulmonary aspergillosis.
• Oral VRCZ has high bioavailability, but drug interactions with enteral nutrition (EN) are not well-documented.
• This case highlights potential VRCZ level alterations during concurrent EN therapy.

Purpose of the Study:

• To report changes in voriconazole (VRCZ) trough levels in a patient receiving continuous enteral nutrition (EN).
• To investigate the impact of EN and administration route on VRCZ bioavailability.

Main Methods:

• A patient with esophageal cancer receiving continuous EN and crushed oral voriconazole (VRCZ) via jejunostomy tube was studied.
• VRCZ trough levels were monitored before and after dose adjustments and changes in administration.
• Enteral nutrition (EN) was temporarily interrupted during VRCZ administration.

Main Results:

• A VRCZ trough level of 0.80 μg/mL was observed when administered via jejunostomy tube during continuous EN.
• Following dose increase, EN reduction, and oral administration, the VRCZ trough level rose to 1.87 μg/mL.
• This indicates a potential decrease in VRCZ absorption when co-administered with EN via a jejunostomy tube.

Conclusions:

• Concurrent administration of VRCZ via jejunostomy tube and continuous EN can lead to decreased VRCZ trough levels.
• Close monitoring of VRCZ levels is essential in patients receiving both EN and VRCZ.
• Adjusting the VRCZ dose, EN regimen, or administration route may be necessary to maintain therapeutic levels.