Influence of switching from intravenous to oral administration on serum voriconazole concentration

Abstract

Voriconazole is a broad-spectrum triazole antifungal agent with potent activity against a range of medically important fungal pathogens. 1,2 Voriconazole is often recommended as the primary treatment for acute invasive aspergillosis and as salvage therapy for serious fungal infections caused by rare moulds such as those of the Scedosporium and Fusarium species in adults, and for the treatment of Candida infections in nonneutropenic adults. 3,4 Voriconazole can be used to prevent invasive fungal infections in immunocompromised patients. 5,6 In several cases with Aspergillus infections, long-term, even lifelong antifungal therapy may be required to control the disease. 3,4 Voriconazole is available in both intravenous and oral forms. Thus, switching from intravenous to oral medication among patients whose clinical condition allows for intake of oral

Safety and Pharmacokinetics of Intravenous and Oral Fosmanogepix, a First-in-Class Antifungal Agent, in Healthy Volunteers

“…to p.o. route of administration has the potential to lower the plasma exposure to ineffectual levels and result in treatment failure ( 31 , 32 ). However, the i.v.…”

Optimal timing for therapeutic drug monitoring of voriconazole to prevent adverse effects in Japanese patients

“…To confirm the optimal timing of the initial TDM, we set a stepwise cutoff for the timing of the initial TDM within a range of 3–6 days after the start of voriconazole treatment. Good to excellent bioavailability has been reported for voriconazole 21,22 . However, there are some differences in the concentrations obtained with the same dose of oral and intravenous administration.…”

“…Good to excellent bioavailability has been reported for voriconazole. 21,22 However, there are some differences in the concentrations obtained with the same dose of oral and intravenous administration. Therefore, voriconazole C min was measured following the route of administration, and the main PK analyses were conducted in patients who received oral voriconazole.…”

Phase 1b safety and pharmacokinetics of intravenous and oral fosmanogepix in patients with acute myeloid leukaemia and neutropenia

“…Existing treatment options may have limited use in patients with IFDs, due to poor tolerability and toxicity, suboptimal drug exposure at the site of infection, reduced bioavailability of oral formulations while switching dosage forms, 8 and pharmacokinetic interactions with other drugs. 9 In addition, switching from IV to oral formulations may lead to poor drug exposures and potentially suboptimal efficacy.…”

“…For example, switching from IV to oral voriconazole led to an 80% decrease in plasma concentrations, although both formulations were administered at the same dose. 8 In patients with ALL receiving vincristine chemotherapy, voriconazole and itraconazole coadministration resulted in significant drug–drug interactions leading to adverse drug reactions prohibiting azole use in those patients. 10 In addition, rates of resistance are increasing and MDR pathogenic fungi that are resistant to treatment with amphotericin B, azoles and echinocandins have been reported.…”