Therapeutic Drug Monitoring for Voriconazole in an Intensive Care Unit: A Case Report

Patients in the intensive care unit need a strict follow-up of their levels of voriconazole because this drug has a narrow therapeutic index and a great intra, and it also presents a great rate of variability related to intra and interindividual pharmacokinetic. Monitoring the plasma levels of voriconazole has demonstrated its efficacy, but data on its safety and adequate dose in patients with liver failure are lacking and it is not recommended intravenously in renal impairment. We present a case report of invasive pulmonary fungal infection in a patient with diagnosis of liver failure who was managed with intravenous voriconazole, the dose was lowered according to the monitoring data; given that he presented hepatotoxicity by voriconazole despite having levels within range. Finally, the patient presents a renal failure and the clinical pharmacist recommends switching to an oral route, using the suspension of voriconazole.