Voriconazole: The Latest Triazole Antifungal Compound
Keywords:
Voriconazole, triazole antifungal, invasive aspergillosis, candidiasis, pharmacokinetics, antifungal resistanceAbstract
Voriconazole, a novel second-generation triazole antifungal, has significantly expanded the therapeutic landscape for invasive fungal infections. Its broad-spectrum activity against Aspergillus spp., Candida spp., Scedosporium apiospermum, and Fusarium spp. makes it a vital agent, particularly in immunocompromised populations. With excellent oral bioavailability (>95%) and the availability of both intravenous and oral formulations, voriconazole offers clinical flexibility and cost-effectiveness, especially when transitioning from hospital to outpatient care. Clinical trials have shown its superior efficacy over amphotericin B in treating invasive aspergillosis and comparable outcomes to fluconazole in esophageal candidiasis. Despite its clinical advantages, voriconazole’s use must be carefully managed due to potential adverse effects such as visual disturbances, hepatotoxicity, and drug–drug interactions via cytochrome P450 enzymes. Genetic polymorphisms, particularly in CYP2C19, can result in significant interindividual variability in metabolism and drug exposure. Resistance, although still limited, has been observed, particularly in azole-resistant fungal strains, raising concerns for future clinical efficacy. Pharmacoeconomic evaluations support voriconazole's cost benefit when oral therapy is introduced early in treatment. In summary, voriconazole represents a powerful tool in antifungal therapy, provided it is used with individualized dosing and vigilant monitoring to mitigate toxicity and resistance risks.
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References
Ben-Ami, R. (2023). Systemic Antifungal Therapy for Invasive Pulmonary Infections. In Journal of Fungi. https://doi.org/10.3390/jof9020144
Dixit, D., Verma, P. K., & Marwaha, R. K. (2021). A review on ‘triazoles’: their chemistry, synthesis and pharmacological potentials. In Journal of the Iranian Chemical Society. https://doi.org/10.1007/s13738-021-02231-x
Greer, N. D. (2003). Voriconazole: The Newest Triazole Antifungal Agent. Baylor University Medical Center Proceedings. https://doi.org/10.1080/08998280.2003.11927910
Groll, A. H., Townsend, R., Desai, A., Azie, N., Jones, M., Engelhardt, M., Schmitt-Hoffman, A. H., & Brüggemann, R. J. M. (2017). Drug-drug interactions between triazole antifungal agents used to treat invasive aspergillosis and immunosuppressants metabolized by cytochrome P450 3A4. In Transplant Infectious Disease. https://doi.org/10.1111/tid.12751
Hong, Y. D., Villalonga-Olives, E., & Perfetto, E. M. (2019). Patient-Reported Outcomes in Orphan Drug Labels Approved by the US Food and Drug Administration. Value in Health. https://doi.org/10.1016/j.jval.2019.03.010
Johnson, L. B., & Kauffman, C. A. (2003). Voriconazole: A new triazole antifungal agent. In Clinical Infectious Diseases. https://doi.org/10.1086/367933
Kofla, G., & Ruhnke, M. (2005). Voriconazole: Review of a broad spectrum triazole antifungal agent. In Expert Opinion on Pharmacotherapy. https://doi.org/10.1517/14656566.6.7.1215
Lee, J. S., Kim, H. S., Jung, Y. S., Choi, H. G., & Kim, S. H. (2021). Pharmacokinetic drug interaction between tofacitinib and voriconazole in rats. Pharmaceutics. https://doi.org/10.3390/pharmaceutics13050740
Lestrade, P. P., Bentvelsen, R. G., Schauwvlieghe, A. F. A. D., Schalekamp, S., Van Der Velden, W. J. F. M., Kuiper, E. J., Van Paassen, J., Van Der Hoven, B., Van Der Lee, H. A., Melchers, W. J. G., De Haan, A. F., Van Der Hoeven, H. L., Rijnders, B. J. A., Van Der Beek, M. T., & Verweij, P. E. (2019). Voriconazole resistance and mortality in invasive aspergillosis: A multicenter retrospective cohort study. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciy859
Li, H., Zhang, M., Jiao, X., Zhu, Y., Liu, Y., Zeng, L., Wang, H., Zhang, L., Zhang, W., & Zhang, L. (2023). Using disproportionality analysis to explore the association between periostitis and triazole antifungals in the FDA Adverse Event Reporting System Database. Scientific Reports. https://doi.org/10.1038/s41598-023-27687-0
Logan, A., Wolfe, A., & Williamson, J. C. (2022). Antifungal Resistance and the Role of New Therapeutic Agents. In Current Infectious Disease Reports. https://doi.org/10.1007/s11908-022-00782-5
Mikus, G., Scholz, I. M., & Weiss, J. (2011). Pharmacogenomics of the triazole antifungal agent voriconazole. In Pharmacogenomics. https://doi.org/10.2217/pgs.11.18
Moriyama, B., Obeng, A. O., Barbarino, J., Penzak, S. R., Henning, S. A., Scott, S. A., Agúndez, J. A. G., Wingard, J. R., McLeod, H. L., Klein, T. E., Cross, S. J., Caudle, K. E., & Walsh, T. J. (2017). Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C19 and Voriconazole Therapy. Clinical Pharmacology and Therapeutics. https://doi.org/10.1002/cpt.583
Pearson, M. M., Rogers, P. D., Cleary, J. D., Chapman, S. W., Da Camara, C., & Perreault, M. M. (2003). Voriconazole: A new triazole antifungal agent. Annals of Pharmacotherapy. https://doi.org/10.1345/aph.1C261
Sabo, J. A., & Abdel-Rahman, S. M. (2000). Voriconazole: A new triazole antifungal. Annals of Pharmacotherapy. https://doi.org/10.1345/aph.19237
Sutton, S. S. (2003). Voriconazole: A New Triazole Antifungal Agent. In P and T.
Weeraphon, B., Vanichanan, J., & Usayaporn, S. (2020). Successful challenge of voriconazole in a patient with posaconazole-associated minor drug eruption: A case report. Journal of Clinical Pharmacy and Therapeutics. https://doi.org/10.1111/jcpt.13221
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