Subtherapeutic voriconazole concentrations associated with concomitant dexamethasone: case report and review of the literature.
J Clin Pharm Ther 2016;
41:441-443. [PMID:
27207573 DOI:
10.1111/jcpt.12401]
[Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE
Voriconazole has significant drug interactions due to metabolism by CYP enzymes. Subtherapeutic voriconazole concentrations associated with concomitant dexamethasone are not well described.
CASE DESCRIPTION
An 84-year-old male was started on voriconazole for a fungal brain abscess. He was readmitted due to clinical failure thought to be the result of subtherapeutic voriconazole concentrations. Dexamethasone was identified as a potential cause due to its induction of CYP enzymes. This interaction was substantiated by sequential troughs that demonstrated a rise in voriconazole concentrations as dexamethasone was tapered off.
WHAT IS NEW AND CONCLUSION
Therapeutic drug monitoring for patients on voriconazole and dexamethasone is essential to prevent suboptimal clinical outcomes.
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