Voriconazole (VRC) is a broad-spectrum triazole antifungal drug and first-line choice for invasive pulmonary aspergillus (IPA) even in patients with liver failure. But it is limited when used in these individuals due to hepatoxicity and supratherapeutic trough plasma concentrations that could lead to severe adverse events appear or aggravate.
This case reported a 41-year-old Chinese male who suffered from sub-acute liver failure and received VRC for treatment of IPA. Fifteen days later, the patient developed a rare side effect, myopathy, manifested by a sharp increase in muscle enzymes accompanied with severe fatigue. The drug was stopped then because the concentration was supratherapeutic. After that, his symptoms relieved and creatine kinase level decreased to normal range.
To prevent adverse events of VRC in patients with liver deficiency, routine therapeutic drug monitoring (TDM), and dosage adjustment are recommended. In addition, monitoring side effects of the drug is significant as well.
Voriconazole; Myopathy; Liver failure; Adverse event