Inhibition of #CYP3A4 by #voriconazole
Voriconazole is potent inhibitor of CYP3A4. Tacrolimus is extensively metabolized by CYP3A4. When given together, voriconazole inhibits metabolism of tacrolimus, resulting in significantly ⬆️tacrolimus concentrations & ⬆️risk of nephrotoxicity & neurotoxicity.

& triazole resistance is an increasing threats
- Combination therapy has proven effective for other difficult to treat infections, & preclinical studies support triazole echinocandin combinations for #aspergillosis . A #clinicaltrial of #voriconazole + #anidulafungin

https://www.nejm.org/doi/full/10.1056/NEJMicm1814565

t.co/M588nPTtrL
#voriconazole #periostitis

#voriconazole #periostitis Ddx
-hypertrophic osteoarthropathy (often w/malignancies or chronic infections)
-venous stasis w/ periosteal rx
-thyroid acropachy (autoimmune thyroid dz w/ periosteal reactions, clubbing, digital swelling)
-hypervitaminosis A

#periostitis resolves gradually after stopping #voriconazole. Only azole to have 3 three fluorines in the molecule; other azoles have 2 fluorines. One hypothesis 3rd fluorine can be released into blood stream during metabolism of the drug & cause fluorosis.

#voriconazole #periostitis occurs after at least 6 months of therapy, although cases have been reported after 6 weeks of therapy. Serum fluoride levels are characteristically elevated as well as serum alkaline phosphatase

#Voriconazole SE vision changes, rash, nausea, vomiting, abnormal liver function tests, hallucinations
#Periostitis w/ long term voriconazole diffuse body aches, ,inc AlkP patches of periosteal thickening on Xray &+bone scan. Calcified excrescences are sometimes seen.

https://www.ajronline.org/doi/pdf/10.2214/AJR.18.19991

#voriconazole #Periostitis Ref pic t.co/mxnyfGZMFj

Drug-induced fluorosis: A study based on the national and international pharmacovigilance databases Drug-induced fluorosis: A study based on the national and international pharmacovigilance databases

Pharmacovigilance
Drug-induced fluorosis: A study based on the national and international pharmacovigilance databases
#Fluorosis #Pharmacovigilance #Voriconazole #Fluconazole #Fludarabine #Ciprofloxacine #Disporportionality
www.em-consulte.com/article/1751...

💊 This study aimed to detect the #gender variations in #adverse events (AEs) of #voriconazole and promote personalised #medicine.

💻 Read the #OpenAccess paper on our webpage: www.thieme-connect.com/products/ejo...

Successful Treatment of Pulmonary #Scedosporiosis With #Voriconazole and Lobectomy in a Patient With Interstitial #Pneumonia
onlinelibrary.wiley.com/doi/10.1002/...

5➡️Une communication brève ayant pour objectif d’évaluer la diffusion et l'efficacité du #voriconazole chez des patients atteints de candidose urinaire résistante au #fluconazole.

www.sciencedirect.com/science/arti...

#IDSky #Antifungal #FluconazoleResistance #TherapeuticDrugMonitoring

Drug–drug interaction and inadequate exposure to voriconazole in critically ill patients with multiple organ failure: A pediatric case study Drug–drug interaction and inadequate exposure to voriconazole in critically ill patients with multiple organ failure: A pediatric case study

Letter to editor Drug–drug interaction and inadequate exposure to voriconazole in critically ill patients with multiple organ failure: A pediatric case study em-consulte.com/article/1663... #Voriconazole #ContinuousRenalReplacementTherapy #DrugDrugInteraction #Children