From the Research
Voriconazole is associated with neutropenia, a decrease in white blood cell count, rather than leukocytosis, as evidenced by its use in patients with febrile neutropenia and its potential to cause bone marrow suppression or immune-mediated destruction of neutrophils. The mechanism behind voriconazole-induced neutropenia is not fully understood, but it is thought to involve bone marrow suppression or immune-mediated destruction of neutrophils 1. Patients taking voriconazole should have their complete blood counts monitored regularly, especially during the initial weeks of therapy. If neutropenia develops, the healthcare provider may need to adjust the dose, temporarily discontinue the medication, or consider alternative antifungal agents depending on the severity. Other common side effects of voriconazole include visual disturbances, hepatotoxicity, and skin reactions, but neutropenia specifically represents the hematologic concern rather than leukocytosis.
Some studies have compared voriconazole to other antifungal agents, such as liposomal amphotericin B and fluconazole, in terms of efficacy and safety in patients with neutropenia. For example, a study published in 2002 found that voriconazole was as effective as liposomal amphotericin B in treating febrile neutropenia, but had a lower incidence of nephrotoxicity and infusion-related reactions 1. Another study published in 2014 found that liposomal amphotericin B was more effective than voriconazole for empirical therapy of fungal infections in neutropenic cancer patients, and should be preferred 2.
Key points to consider when using voriconazole in patients with neutropenia include:
- Monitoring complete blood counts regularly, especially during the initial weeks of therapy
- Adjusting the dose or discontinuing the medication if neutropenia develops
- Considering alternative antifungal agents if necessary
- Being aware of the potential for visual disturbances, hepatotoxicity, and skin reactions
- Understanding the potential benefits and risks of voriconazole compared to other antifungal agents, such as liposomal amphotericin B and fluconazole.
Overall, voriconazole can cause neutropenia, and patients taking this medication should be closely monitored for signs of bone marrow suppression or immune-mediated destruction of neutrophils.