The evaluation and analysis on the results of voriconazole plasma concentration monitoring

YAN Miao; WANG Ningning; LI Ziwei; JIANG Mengfei; WANG Feng; ZHANG Bikui; XU Ping; XIAO Yiwen

doi:10.3969/j.issn.1006-0111.2016.05.010

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Volume 34 Issue 5

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Article Navigation > Journal of Pharmaceutical Practice and Service > 2016 > 34(5): 421-423,446

YAN Miao, WANG Ningning, LI Ziwei, JIANG Mengfei, WANG Feng, ZHANG Bikui, XU Ping, XIAO Yiwen. The evaluation and analysis on the results of voriconazole plasma concentration monitoring[J]. Journal of Pharmaceutical Practice and Service, 2016, 34(5): 421-423,446. doi: 10.3969/j.issn.1006-0111.2016.05.010

Citation:

YAN Miao, WANG Ningning, LI Ziwei, JIANG Mengfei, WANG Feng, ZHANG Bikui, XU Ping, XIAO Yiwen. The evaluation and analysis on the results of voriconazole plasma concentration monitoring[J]. Journal of Pharmaceutical Practice and Service, 2016, 34(5): 421-423,446. doi: 10.3969/j.issn.1006-0111.2016.05.010

The evaluation and analysis on the results of voriconazole plasma concentration monitoring

doi: 10.3969/j.issn.1006-0111.2016.05.010

1.
The Second Xiangya Hospital of Central South University, Changsha 410011, China;Institute of Clinical Pharmacy, Central South University, Changsha 410011, China
2.
The Second Xiangya Hospital of Central South University, Changsha 410011, China;School of Pharmaceutical Sciences of Central South University, Changsha 410208, China
3.
The Second Xiangya Hospital of Central South University, Changsha 410011, China

Received Date: 2015-08-17
Rev Recd Date: 2014-12-01

Abstract

Objective To clarify the necessity of therapeutic drug monitoring (TDM) of voriconazole, and give relevant clinical tips, by comparing the plasma concentration of different clinical specialties before and after adjustment of dose. Methods This is a retrospective study of voriconazole TDM data. It involves 435 cases voriconazole plasma trough concentration measurement results of 154 inpatients to make a preliminary assessment. Results 4.3% plasma concentration were higher than 5.5 μg/ml, 26.5% plasma concentration were less than 1.0 μg/ml in renal transplantation department; while 52.3% plasma concentration were higher than 5.5 μg/ml, no less than 1.0 μg/ml in infectious disease department. Conclusions Therapeutic drug monitoring is necessary for rational use of voriconazole. The majority of plasma concentrations in renal transplantation patients were <1.0 μg/ml, lower than recommended treatment concentration range; while most infectious disease patients have > 5.5 μg/ml, higher than recommended treatment concentration range. Clinical pharmacists can be more closely involved in the clinical use of voriconazole based on the results of the therapeutic drug monitoring.
- voriconazole,
- TDM,
- renal transplantation department,
- infectious disease department

References

[1]	Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis,2008,46:327-360.[2] Theuretzbacher U, Ihle F, Derendorf H. Pharmacokinetic/pharmacodynamic profile of voriconazole[J]. Clin Pharmacokinet, 2006, 45:649-663.
[2]	Cocchi S, Codeluppi M, Venturelli C,et al. Fusarium verticillioides fungemia in a liver transplantation patient: successful treatment with voriconazole[J]. Diagn Microbiol Infect Dis,2011, 71:438-441.
[3]	Voriconazole (Package Insert), Revised Version[Z]. New York, NY: Pfizer, 2011.
[4]	Hyland R, Jones BC, Smith DA. Identification of the cytochrome P450 enzymes involved in the N-oxidation of voriconazole[J]. Drug Metab Dispos, 2003,31:540-547.
[5]	Van Gelder T, Le Meur Y, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation[J]. Ther Drug Monit, 2006, 28(2):145-154.
[6]	Thomson AH, Whiting B. Bayesian parameter estimation and population pharmacokinetics[J].Clin Pharmaeokinet,1992, 22(6):447-467.
[7]	纪宇,黄晓军.关于《血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)》治疗原则部分的解读[J].临床药物治疗杂志,2008,6(1):14-18.
[8]	骆雪萍,梅铭惠.重症监护病房侵袭性真菌感染特点及诊断[J].重庆医学,2010,39 (17):2389-2391.
[9]	Hamadad Y, Seto Y, Yago K,et al. Investigation and threshold of optimum blood concentration of voriconazole: a descriptive statistical metaanalysis[J]. J Infect Chemother,2012, 18:501-507.
[10]	Kim KH, Lee S, Lee S,et al. Voriconazole-associated severe hyponatremia[J]. Med Mycol,2012,50:103-105.
[11]	Matsumoto K, Ikawa K, Abematsu K,et al. Correlation between voriconazole trough plasma concentration and hepatotoxicity in patients with different CYP2C19 genotypes[J]. Int J Antimicrob Agents,2009,34:91-94.
[12]	Park WB, Kim NH, Kim KH,et al. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial[J]. Clin Infect Dis,2012, 55:1080-1087.
[13]	De Pauw B, Walsh TJ, Donnelly JP, et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group[J]. Clin Infect Dis,2008, 46(12):1813-1821.
[14]	付双双,熊歆,翟所迪,等.伏立康唑患者血药浓度监测[J].中国临床药理学杂志,2013,29 (8):622-624.
[15]	蔡然,张杰根,刘晓蒙,等.42例伏立康唑治疗肺真菌感染患者的不良反应[J].临床药物治疗杂志,2013,11 (2):49-51.
[16]	解建,张明,李涛,等.伏立康唑治疗101例重症患者侵袭性真菌感染的临床分析[J].中华医院感染学杂志,2012,22 (4):811-813.
[17]	Dolton MJ,Ray JE,Chen SC,et al. Multicenter study of voriconazole pharmacokinetics and therapeutic drug monitoring[J]. Antimicrob Agents Chemother, 2012,56(9):4793-4799.
[18]	Pai MP, Allen S. Voriconazole inhibition of tacrolimus metabolism[J]. Clin Infect Dis, 2003, 36:1089-1091.
[19]	Chang HH, Lee NY, Ko WC, et al. Voriconazole inhibition of tacrolimus metabolism in a kidney transplant recipient with fluconazole-resistant cryptococcal meningitis [J]. Int J Infec Dis, 2010,14(4):348 -350.
[20]	Venkataramana R, Zang S, Gayowski T, et al.Voriconazoleinhibition of the metabolism of Tacrolimus in a liver transplant recipient and in human liver microsomes [J].Antimicrob Agents Chemother,2002,46(9): 3091-3093.
[21]	王柠柠,梁武,颜苗,等.在本院患者中建立伏立康唑群体药物代谢动力学模型的初步探索[J].中南药学,2015,11(3):1174-1177.

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通讯作者: 陈斌, bchen63@163.com

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沈阳化工大学材料科学与工程学院沈阳 110142

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The evaluation and analysis on the results of voriconazole plasma concentration monitoring

1. The Second Xiangya Hospital of Central South University, Changsha 410011, China;Institute of Clinical Pharmacy, Central South University, Changsha 410011, China

2. The Second Xiangya Hospital of Central South University, Changsha 410011, China;School of Pharmaceutical Sciences of Central South University, Changsha 410208, China

3. The Second Xiangya Hospital of Central South University, Changsha 410011, China

Received Date: 2015-08-17

Rev Recd Date: 2014-12-01

Key words:

Abstract: Objective To clarify the necessity of therapeutic drug monitoring (TDM) of voriconazole, and give relevant clinical tips, by comparing the plasma concentration of different clinical specialties before and after adjustment of dose. Methods This is a retrospective study of voriconazole TDM data. It involves 435 cases voriconazole plasma trough concentration measurement results of 154 inpatients to make a preliminary assessment. Results 4.3% plasma concentration were higher than 5.5 μg/ml, 26.5% plasma concentration were less than 1.0 μg/ml in renal transplantation department; while 52.3% plasma concentration were higher than 5.5 μg/ml, no less than 1.0 μg/ml in infectious disease department. Conclusions Therapeutic drug monitoring is necessary for rational use of voriconazole. The majority of plasma concentrations in renal transplantation patients were <1.0 μg/ml, lower than recommended treatment concentration range; while most infectious disease patients have > 5.5 μg/ml, higher than recommended treatment concentration range. Clinical pharmacists can be more closely involved in the clinical use of voriconazole based on the results of the therapeutic drug monitoring.

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Reference (21)

[1]	Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis,2008,46:327-360.[2] Theuretzbacher U, Ihle F, Derendorf H. Pharmacokinetic/pharmacodynamic profile of voriconazole[J]. Clin Pharmacokinet, 2006, 45:649-663.
[2]	Cocchi S, Codeluppi M, Venturelli C,et al. Fusarium verticillioides fungemia in a liver transplantation patient: successful treatment with voriconazole[J]. Diagn Microbiol Infect Dis,2011, 71:438-441.
[3]	Voriconazole (Package Insert), Revised Version[Z]. New York, NY: Pfizer, 2011.
[4]	Hyland R, Jones BC, Smith DA. Identification of the cytochrome P450 enzymes involved in the N-oxidation of voriconazole[J]. Drug Metab Dispos, 2003,31:540-547.
[5]	Van Gelder T, Le Meur Y, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation[J]. Ther Drug Monit, 2006, 28(2):145-154.
[6]	Thomson AH, Whiting B. Bayesian parameter estimation and population pharmacokinetics[J].Clin Pharmaeokinet,1992, 22(6):447-467.
[7]	纪宇,黄晓军.关于《血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)》治疗原则部分的解读[J].临床药物治疗杂志,2008,6(1):14-18.
[8]	骆雪萍,梅铭惠.重症监护病房侵袭性真菌感染特点及诊断[J].重庆医学,2010,39 (17):2389-2391.
[9]	Hamadad Y, Seto Y, Yago K,et al. Investigation and threshold of optimum blood concentration of voriconazole: a descriptive statistical metaanalysis[J]. J Infect Chemother,2012, 18:501-507.
[10]	Kim KH, Lee S, Lee S,et al. Voriconazole-associated severe hyponatremia[J]. Med Mycol,2012,50:103-105.
[11]	Matsumoto K, Ikawa K, Abematsu K,et al. Correlation between voriconazole trough plasma concentration and hepatotoxicity in patients with different CYP2C19 genotypes[J]. Int J Antimicrob Agents,2009,34:91-94.
[12]	Park WB, Kim NH, Kim KH,et al. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial[J]. Clin Infect Dis,2012, 55:1080-1087.
[13]	De Pauw B, Walsh TJ, Donnelly JP, et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group[J]. Clin Infect Dis,2008, 46(12):1813-1821.
[14]	付双双,熊歆,翟所迪,等.伏立康唑患者血药浓度监测[J].中国临床药理学杂志,2013,29 (8):622-624.
[15]	蔡然,张杰根,刘晓蒙,等.42例伏立康唑治疗肺真菌感染患者的不良反应[J].临床药物治疗杂志,2013,11 (2):49-51.
[16]	解建,张明,李涛,等.伏立康唑治疗101例重症患者侵袭性真菌感染的临床分析[J].中华医院感染学杂志,2012,22 (4):811-813.
[17]	Dolton MJ,Ray JE,Chen SC,et al. Multicenter study of voriconazole pharmacokinetics and therapeutic drug monitoring[J]. Antimicrob Agents Chemother, 2012,56(9):4793-4799.
[18]	Pai MP, Allen S. Voriconazole inhibition of tacrolimus metabolism[J]. Clin Infect Dis, 2003, 36:1089-1091.
[19]	Chang HH, Lee NY, Ko WC, et al. Voriconazole inhibition of tacrolimus metabolism in a kidney transplant recipient with fluconazole-resistant cryptococcal meningitis [J]. Int J Infec Dis, 2010,14(4):348 -350.
[20]	Venkataramana R, Zang S, Gayowski T, et al.Voriconazoleinhibition of the metabolism of Tacrolimus in a liver transplant recipient and in human liver microsomes [J].Antimicrob Agents Chemother,2002,46(9): 3091-3093.
[21]	王柠柠,梁武,颜苗,等.在本院患者中建立伏立康唑群体药物代谢动力学模型的初步探索[J].中南药学,2015,11(3):1174-1177.

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The evaluation and analysis on the results of voriconazole plasma concentration monitoring

doi: 10.3969/j.issn.1006-0111.2016.05.010

Abstract

References

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通讯作者: 陈斌, bchen63@163.com

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