Voriconazole nephrotoxicity

In patients who cannot tolerate voriconazole, amphotericin B can be used. Full doses (1 to 1.5 mg/kg/day) are generally recommended, with response measured by defervescence and radiographic clearing. The lipid-based formulations may be preferred as initial therapy in patients with marginal renal function or in patients receiving other nephrotoxic drugs. The optimal duration of treatment is unknown. 

CICLOSPORIN AZOLES - ITRACONAZOLE, KETOCONAZOLE, VORICONAZOLE t plasma concentrations of ciclosporin, with risk of nephrotoxicity, myelosuppression, neurotoxicity, excessive immunosuppression, with risk of infection and post-transplant lymphoproliferative disease Inhibition of CYP3A4-mediated metabolism of ciclosporin these inhibitors vary in potency. Ketoconazole and itraconazole are classified as potent inhibitors. Effect not clinically relevant with fluconazole Avoid co-administration with itraconazole or ketoconazole. Consider alternative azole but need to monitor plasma ciclosporin levels to prevent toxicity... 

A large, randomized, multicenter trial that compared voriconazole with hposomal amphotericin B for empirical antifungal therapy showed comparable composite success rates however, voriconazole did not fulfill the protocol-defined criteria for noninferiority to liposomal amphotericin. Voriconazole was superior in reducing documented breakthrough infections, infusion-related toxicity, and nephrotoxicity. However, patients who received voriconazole had more frequent... 

A 58-year-old man with acute liver failure received tacrolimus (3 mg b.i.d) 8 days after liver transplantation [61 ]. On day 11 after transplantation, A. fumigatus was cultured from broncho-alveolar lavage and voriconazole started. At the same time tacrolimus dose was reduced to 30% to avoid toxicity. Oral voriconazole was started on day 21 to avoid nephrotoxicity, which... 

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