Practice guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring


Yukihiro Hamada • Issei Tokimatsu • Hiroshige Mikamo • Masao Kimura • Masafumi Seki •
Shunji Takakura • Norio Ohmagari • Yoshiko Takahashi • Kei Kasahara • Kazuaki Matsumoto •
Kenji Okada • Masahiro Igarashi • Masahiro Kobayashi • Takahiro Mochizuki •
Yoshifumi Nishi • Yusuke Tanigawara • Toshimi Kimura • Yoshio Takesue
Received: 21 January 2013 / Accepted: 15 April 2013 / Published online: 15 May 2013
The Author(s) 2013. This article is published with
Keywords Guideline Voriconazole Therapeutic drug monitoring
Introduction
Voriconazole (VRCZ) is a triazole antifungal developed
for the treatment of fungal infectious disease and is available
for both oral and intravenous administration. It has
potent activity against a broad spectrum of clinically significant
pathogens, including Aspergillus, Candida, Cryptococcus,
Fusarium, and Scedosporium [1]. VRCZ has a
nonlinear pharmacokinetic profile with wide inter- and
intraindividual variability [2]. This variability is caused by
many factors, such as sex, age, race, genotypic variation,
liver dysfunction, and the presence of food. Another
important factor influencing the VRCZ pharmacokinetic
profile is drug–drug interactions with CYP450 inhibitors as
well as inducers. Genotypic variation in the metabolizing