Hepatotoxicity voriconazole

Luong ML, Hosseini-Moghaddam SM, Singer LG, Chaparro C, Azad S, Lazar N, et al. Risk factors for voriconazole hepatotoxicity at 12 weeks in lung transplant recipients. Am J Transplant 2012 12(7) 1929-35. 

SoMs-Munoz P, Lopez JG, Bernal W, Wniars C, Verma A, HeneghanMA, et al. Voriconazole hepatotoxicity in severe liver dysfunction. J Infect... 

Micafungin Topical 0.1% solution 1 drop ql h while awake Side effects include pulmonary edema, blood dyscrasias, hypercalcemia, hepatotoxicity (rare), gastrointestinal symptoms, headache, fever, chills, anemia, eosinophilia, hypokalemia, liver function test elevations, infusion site reactions. Drug interaction with cyclosporine and additional voriconazole. Pregnancy category C lactation safety unknown. Coadministration of caspofungin is contraindicated with multiple antiretrovirals (refer to Table 11-3) Topical not commercially available... 

Liver In a retrospective review of 200 adult and pediatric recipients of hemopoietic stem cell transplants who took more than two consecutive doses of voriconazole, clinical hepatotoxicity was defined as any rises in liver enzymes (aminotransferases and alkaline phosphatase) that led to withdrawal of voriconazole and biochemical hepatotoxicity as a rise in one or more liver enz5nnes to more than three times the upper limit of the reference range or more than three times the baseline value if abnormal at... 

Observational studies Of 72 patients undergoing allogeneic transplantation who were given voriconazole as antifungal prophylaxis starting from 2 days before transplantation and continuing until withdrawal of immunosuppression, 10 required interruption of voriconazole therapy because of adverse effects hepatotoxicity ( = 6), QT interval prolongation (n = 1), or other adverse effects ( = 4) [68]. 

It is difficult to ascertain the role of each drug in this case, as both voriconazole and bromazepam can cause neurological toxicity and raised liver enzymes. However, this report shows that a very large overdose of voriconazole with high blood concentrations does not necessarily result in severe clinical complications or death, but that delayed hepatotoxicity can occur. 

Cadena J, Levine DJ, Angel LF, Maxwell PR, Brady R, Sanchez JF, Michalek JE, Levine SM, Restrepo MI. Antifungal prophylaxis with voriconazole or itraconazole in lung transplant recipients hepatotoxicity and effectiveness. Am J Transplant 2009 9 2085-91. 

Liver Hepatotoxicity was retrospectively evaluated in a cohort study in 105 lung transplant recipients taking voriconazole [25 ]. Age less than 40 years, cystic fibrosis, use of azathioprine, history of liver disease and early initiation of voriconazole were associated with hepatotoxicity and in multivariable logistic regression analysis, perioperative initiation of voriconazole was independently associated with hepatotoxicity. 

Hepatotoxicity after taking voriconazole was evaluated in patients with severe liver dysfunction [26 ]. During voriconazole, 69% of patients showed changes in liver function tests all these patients were considered having severe reactions. 

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