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Necessity for a Significant Maintenance Dosage Reduction of Voriconazole in Patients with Severe Liver Cirrhosis (Child-Pugh Class C).
- Source :
-
Biological & pharmaceutical bulletin [Biol Pharm Bull] 2018 Jul 01; Vol. 41 (7), pp. 1112-1118. Date of Electronic Publication: 2018 May 11. - Publication Year :
- 2018
-
Abstract
- Therapeutic drug monitoring for voriconazole, an antifungal agent, is essential for maximizing efficacy and preventing toxicity. The aim of this study was to elucidate the optimal maintenance dose of voriconazole in patients with severe liver cirrhosis (Child-Pugh class C) by reviewing the plasma trough concentrations obtained by therapeutic drug monitoring and daily doses of voriconazole. We retrospectively evaluated 6 patients with Child-Pugh class C cirrhosis who received oral voriconazole treatment and were liver transplant recipients or were awaiting liver transplantation. We compared their voriconazole trough concentrations and daily maintenance doses to those of patients who did not have liver cirrhosis (n=56). We found that plasma voriconazole trough concentrations in all patients with Child-Pugh class C were almost within therapeutic range, and the median plasma trough concentration at steady state was not significantly different from that of patients who did not have liver cirrhosis. In addition, the median daily maintenance dose of voriconazole was significantly lower (2.13 mg/kg/d) than that of the control patients (6.27 mg/kg/d), suggesting that trough voriconazole concentrations are elevated in Child-Pugh class C patients. Thus, we conclude that oral voriconazole maintenance doses in patients with Child-Pugh class C should be reduced to approximately one-third that of patients with normal liver function, with the follow-up dose adjusted by therapeutic drug monitoring.
- Subjects :
- Administration, Oral
Antifungal Agents pharmacokinetics
Female
Humans
Liver physiopathology
Liver Cirrhosis blood
Liver Cirrhosis complications
Male
Middle Aged
Mycoses blood
Mycoses complications
Retrospective Studies
Severity of Illness Index
Voriconazole pharmacokinetics
Antifungal Agents administration & dosage
Drug Monitoring
Liver Cirrhosis physiopathology
Mycoses drug therapy
Voriconazole administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1347-5215
- Volume :
- 41
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Biological & pharmaceutical bulletin
- Publication Type :
- Academic Journal
- Accession number :
- 29760306
- Full Text :
- https://doi.org/10.1248/bpb.b18-00164