Voriconazole Dose Reduction Often Fails to Correct High Troughs
A repeated-monitoring inpatient cohort shows that supratherapeutic voriconazole concentrations frequently persist after dose reduction, reframing how TDM pharmacists should sequence and time follow-up sampling.
Voriconazole TDM reveals persistent supratherapeutic levels after dose adjustment in hospitalised patients.
Voriconazole has a narrow therapeutic range, making therapeutic drug monitoring (TDM) crucial to prevent toxicity and ensure efficacy. Out of 497 TDM episodes, 14.5% were subtherapeutic and 29.2% were supratherapeutic, with specific factors identified for each. Only 34.7% of dose decreases normalized supratherapeutic levels. This study highlights the complexities of managing voriconazole TDM in hospital settings, especially after dose adjustments fail to bring levels back to range. Supratherapeutic voriconazole levels often persist despite dose reductions, indicating the need for careful TDM interpretation.
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Authors:He T, Liu Z, Liang L, Qiao W, Chen S, Liu J, Liu M, Li W
Citation:He T, Liu Z, Liang L, et al. Repeated voriconazole therapeutic drug monitoring in hospitalised patients: a real-world cohort study of out-of-range exposure and concentration response to dose adjustment. Frontiers in pharmacology. 2026;17:1867435. doi:10.3389/fphar.2026.1867435
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Executive Summary
Study Design
Patient Population
Primary Outcomes
Secondary Outcomes & Safety Profile
Pharmacist Implications
Clinical Pearls
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