PMID- 37548457
OWN - NLM
STAT- MEDLINE
DCOM- 20230914
LR  - 20230914
IS  - 0946-1965 (Print)
IS  - 0946-1965 (Linking)
VI  - 61
IP  - 10
DP  - 2023 Oct
TI  - Voriconazole-induced visual abnormality based on drug interaction between 
      voriconazole and esomeprazole: A case report.
PG  - 460-465
LID - 10.5414/CP204321 [doi]
AB  - We report a case of voriconazole-induced visual abnormality based on drug 
      interaction of voriconazole and esomeprazole, therapeutic drug monitoring, and 
      optimal therapy. An 81-year-old male developed visual abnormality after the blood 
      concentration of voriconazole was up to 6.47 mg/L induced by coadministration 
      with esomeprazole. Voriconazole is a substrate of multiple CYP450 isoenzymes 
      including CYP2C19 (the major route), CYP3A4, and CYP2C9. Esomeprazole, a proton 
      pump inhibitor (PPI), is also converted to inactive metabolites through CYP3A4 
      and CYP2C19-mediated metabolism, and is also a CYP2C19 inhibitor. The 
      coadministration with esomeprazole inhibited the metabolism of voriconazole via 
      CYP2C19 and promoted the elevation of voriconazole blood concentration beyond the 
      minimum toxic level (5.5 mg/L). According to the pharmacist's advice, the adverse 
      effects of visual abnormalities in the patient disappeared after the clinician 
      reduced voriconazole dosage by 50% when other medication schedules remained 
      unchanged. Therefore, therapeutic drug monitoring of voriconazole should be 
      considered in patients receiving PPIs, especially esomeprazole, in order to 
      adjust the dosage in time and achieve optimal therapeutic response and minimal 
      adverse reaction.
FAU - Jiang, Zhouqian
AU  - Jiang Z
FAU - Li, Jia
AU  - Li J
FAU - Zhao, Chengfei
AU  - Zhao C
FAU - Chen, Jie
AU  - Chen J
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Germany
TA  - Int J Clin Pharmacol Ther
JT  - International journal of clinical pharmacology and therapeutics
JID - 9423309
RN  - N3PA6559FT (Esomeprazole)
RN  - JFU09I87TR (Voriconazole)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP2C19)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP3A)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Male
MH  - Humans
MH  - Aged, 80 and over
MH  - *Esomeprazole/adverse effects
MH  - Voriconazole/adverse effects
MH  - Cytochrome P-450 CYP2C19/genetics/metabolism
MH  - *Cytochrome P-450 CYP3A
MH  - Proton Pump Inhibitors/adverse effects
MH  - Drug Interactions
EDAT- 2023/08/07 13:09
MHDA- 2023/09/14 06:42
CRDT- 2023/08/07 09:03
PHST- 2023/09/06 00:00 [accepted]
PHST- 2023/09/14 06:42 [medline]
PHST- 2023/08/07 13:09 [pubmed]
PHST- 2023/08/07 09:03 [entrez]
AID - 190535 [pii]
AID - 10.5414/CP204321 [doi]
PST - ppublish
SO  - Int J Clin Pharmacol Ther. 2023 Oct;61(10):460-465. doi: 10.5414/CP204321.