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Published on: February 18, 2012

Voriconazole and Dexamethasone Drug Interaction in a Premature Neonate

Caren J Liviskie1, Christine R Lockowitz1, Christopher C McPherson1,2

  • 1Department of Pharmacy (CJL, CRL, CCM), St. Louis Children's Hospital, St. Louis, MO.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|August 11, 2026
PubMed

Insights

Neonatal invasive fungal infections are rising. This case highlights a potential drug interaction between voriconazole and dexamethasone in preterm neonates, impacting voriconazole dosing and serum concentrations.

Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Infectious Diseases

Background:

  • Neonatal invasive fungal infections (IFI) caused by Aspergillus species are increasingly prevalent.
  • Voriconazole is a primary antifungal treatment, but its use in premature neonates presents pharmacokinetic challenges.
  • Potential drug interactions with voriconazole in preterm infants remain poorly understood.

Purpose of the Study:

  • To report a case of voriconazole use in a preterm neonate with cutaneous Aspergillosis.
  • To investigate variable serum voriconazole concentrations potentially related to drug interactions.
  • To highlight the impact of dexamethasone on voriconazole pharmacokinetics in neonates.

Main Methods:

  • Case report of a preterm neonate treated for invasive Aspergillus infection.
  • Therapeutic drug monitoring of serum voriconazole concentrations.
  • Analysis of voriconazole levels during concomitant dexamethasone therapy and after its discontinuation.

Main Results:

  • Initial voriconazole doses were subtherapeutic despite escalation.
  • Serum voriconazole concentrations increased to supratherapeutic levels as dexamethasone was tapered.
  • Voriconazole levels remained supratherapeutic after dexamethasone discontinuation, even on the same voriconazole dose.

Conclusions:

  • This case suggests a potential drug interaction between voriconazole and dexamethasone in a preterm neonate.
  • The interaction may lead to unpredictable fluctuations in serum voriconazole concentrations.
  • Careful drug interaction evaluation and therapeutic drug monitoring are crucial for voriconazole dosing in preterm infants.
Keywords:
drug interactionneonateprematurityvoriconazole

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