Abstract
There are no studies regarding to these effects in patients with severe liver dysfunction.
Objectives: The aims of this study were to characterize voriconazole hepatotoxicity in patients with severe liver dysfunction and to compare it with a matched cohort treated with liposomal amphotericin B.
Methods: This is an observational study, in which adults patients treated with at least 4 doses of voriconazole were included. Patients treated with liposomal amphotericin B were used as control group.
Results: Sixty nine percent of patients treated with voriconazole showed changes in liver function tests (LFTs) during therapy. They showed elevated transaminases in 35%, cholestasis in 15% or a combination of both in 45%. According to the CTC classification, all patients with hepatotoxicity had a severe reaction. The Roussel Uclaf Causality Assessment Method score in all patients with hepatotoxicity was greater than 8. There was a correlation between initial loading dose greater than 300 mg (4.5 mg/kg) and the risk of hepatotoxicity (p <0.001). The control group developed alterations in the LFTs in only 10.3% of patients.
Conclusion: Voriconazole should be used with caution in patients with severe liver dysfunction and following liver transplantation, with frequent monitoring of LFTs or using liposomal amphotericin B instead. Crown Copyright (C) 2012 Published by Elsevier Ltd on behalf of The British Infection Association. All rights reserved.
| Original language | English |
|---|---|
| Pages (from-to) | 80-86 |
| Number of pages | 7 |
| Journal | Journal of Infection |
| Volume | 66 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2013 |
Keywords
- Voriconazole
- Hepatotoxicity
- Invasive aspergillosis
- Severe liver dysfunction
- Liver transplantation
- INVASIVE ASPERGILLOSIS
- FUNGAL-INFECTIONS
- CLINICAL-PRACTICE
- AMPHOTERICIN-B
- DRUG
- DISEASE
- PROPHYLAXIS
- FLUCONAZOLE
- THERAPY
- TRIAL