Blurred vision voriconazole

Select azole antifungals (e.g., itraconazole, voriconazole, and posaconazole) and the echinocandins are available for IA treatment. For initial therapy of IA, voriconazole had higher response and survival rates than c-AMB.102 An advantage of voriconazole is its 96% oral bioavailability, making use of this oral drug an attractive and less expensive alternative. The dose of voriconazole was 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours for at least 7 days, at which time oral voriconazole 200 mg every 12 hours could be administered. Common toxicities reported with voriconazole include infusion-related, transient visual disturbances (i.e., blurred vision, altered color perception, photophobia, and visual hallucinations), skin reactions (i.e., rash, pruritus, and photosensitivity), elevations in hepatic transaminases and alkaline phosphatase, nausea, and headache.102 In addition, voriconazole increases the serum concentrations of medications cleared by cytochrome P-450 2C9, 2C19, and 3A4 (e.g., cyclophosphamide and calcineurin inhibitors) concomitant voriconazole-sirolimus should be avoided.103... 

Adverse Effects. Skin rashes and vision disturbances (blurred vision, seeing bright spots) are common during voriconazole administration, but these side effects are usually transient and fairly uneventful. Serious problems, such as liver toxicity and cardiac arrhythmias, may occur in susceptible patients. 

ITRACONAZOLE, KETOCONAZOLE, MICONAZOLE, FLUCONAZOLE, VORICONAZOLE TCAs Possible t plasma concentrations of TCAs All TCAs are metabolized primarily by CYP2D6. Other pathways include CYP1A2 (e.g. amitriptyline, clomipramine, imipramine), CYP2C9 and CYP2C19(e.g. clomipramine, imipramine). Ketoconazole and voriconazole are documented inhibitors of CYP2C19. Fluconazole and voriconazole are reported to inhibit CYP2C9 Warn patients to report t side-effects of TCAs such as dry mouth, blurred vision and constipation, which may be an early sign of t TCA levels. In this case, consider 1 dose of TCA... 

Antifungal drugs Nystatin and natamydn are toxic to the retina and should not be given intravitreally. Voriconazole seems to be non-toxic according to in vitro studies and several case reports however, blurred vision, halos, altered color perception, and visual hallucinations can occur. 

Visual disturbances are common, occurring in up to 30% of patients receiving voriconazole, and include blurring and changes in color vision or brightness. These visual changes usually occur... 

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