Elevated blood concentration and liver injury due to oral administration of overdose voriconazole
Department of Pharmacy, the First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou 215006, China; Department of Pharmacy, Changshu First People′s Hospital, Jiangsu Province, Changshu 215500, China
Abstract：A 51-year-old female patient with lymphadenoma developed neutrophil deficiency with fever after chemotherapy. Voriconazole 1.0 g twice daily was given orally following the doctor’s advice (the recommended dose by drug label is 0.2-0.4g twice daily). the patient took voriconazole 3 times with total dose of 3.0 g within 24 hours. The medication error was found by a pharmacist and voriconazole was stopped. The voriconazole blood concentrations after 12, 24, 36, and 48 hours of drug withdrawal were 12.20, 10.20, 6.55, and 4.45 mg/L, respectively. The laboratory tests showed alanine aminotransferase (ALT) 11 U/L, aspartate aminotransferase (AST) 6 U/L, and γ-glutamyl transpeptidase (γ-GT) 44 U/L before medication and ALT 327 U/L, AST 153 U/L, andγ-GT 627 U/L after 2 days of drug withdrawal, respectively. Overdose of voriconazole-induced liver injury were considered. The patient received the liver-protective therapy including an IV infusion of compound glycyrrhizin injection and oral bicyclol. After 3 days of drug withdrawal, the voriconazole blood concentration was 0.67 mg/L and the laboratory tests showed ALT 191 U/L, AST 31 U/L, and γ-GT 522 U/L. After 16 days of drug withdrawal, the laboratory tests showed 24 U/L, 15 U/L, and 224 U/L, respectively.
