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Boosting of Voriconazole Levels With Omeprazole, A CYP450 2C19 Inhibitor

Alice J Hsu1, Carlton K K Lee1, John McAteer2

  • 1From the Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.

The Pediatric Infectious Disease Journal
|March 14, 2023
PubMed

Insights

Children need higher voriconazole doses due to faster metabolism. Adding omeprazole, a CYP2C19 inhibitor, effectively boosted voriconazole levels in a pediatric fusariosis case.

Area of Science:

  • Pediatric pharmacology
  • Mycology
  • Infectious diseases

Background:

  • Voriconazole is a critical antifungal agent.
  • Children exhibit accelerated voriconazole metabolism compared to adults.
  • Higher weight-based doses and frequent administration are often necessary for pediatric patients to reach therapeutic voriconazole trough concentrations.

Observation:

  • A 4-year-old girl presented with disseminated fusariosis.
  • The patient exhibited persistently undetectable voriconazole trough levels despite dose adjustments.
  • Fusariosis is a serious fungal infection often requiring aggressive treatment.

Findings:

  • Omeprazole was administered as a cytochrome P450 2C19 (CYP2C19) inhibitor.
  • The addition of omeprazole successfully increased voriconazole concentrations in the pediatric patient.
  • This intervention aimed to overcome the rapid metabolism of voriconazole in children.

Implications:

  • This case demonstrates the potential utility of omeprazole as a voriconazole booster in pediatric patients.
  • Targeted inhibition of CYP2C19 may be a viable strategy to enhance voriconazole efficacy in children.
  • Further research into drug-drug interactions and optimized dosing strategies for pediatric antifungal therapy is warranted.

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