From the Guidelines
Voriconazole is associated with a range of common side effects, including visual disturbances, gastrointestinal issues, skin reactions, liver function abnormalities, and neurological effects, which can impact patient morbidity, mortality, and quality of life. The most common side effects of voriconazole include:
- Visual disturbances, such as photopsia, which are transient and self-limited 1
- Gastrointestinal issues, including nausea, vomiting, and diarrhea 1
- Skin reactions, ranging from mild rashes to severe reactions like erythroderma and photosensitivity 1
- Liver function abnormalities, which may be dose-limiting and require regular monitoring of liver enzymes during treatment 1
- Neurological effects, including visual or auditory hallucinations, and reversible central and peripheral neurologic symptoms 1
- Cardiovascular events, including tachyarrhythmias and QT interval prolongations on electrocardiography, which can be life-threatening in rare cases 1 It is essential to monitor patients closely for these side effects, especially when using voriconazole for prolonged periods or in combination with other medications that may interact with it 1. Regular measurement of serum levels is crucial to evaluate potential toxicity or document adequate drug exposure, especially in progressive infection. Additionally, patients should be advised to avoid direct sunlight and use sun protection to minimize the risk of photosensitivity and skin cancer 1.
From the FDA Drug Label
Table 4: Treatment Emergent Adverse Events Rate ≥ 2% on Voriconazole or Adverse Events of Concern in Therapeutic Studies Population, Studies 307/602-608 Combined, or Study 305 Possibly Related to Therapy or Causality Unknown
Special Senses*** Abnormal vision 310 (18.7) Photophobia 37 (2.2) Chromatopsia 20 (1.2)
Body as a Whole Fever 94 (5.7) Chills 61 (3.7) Headache 49 (3.0)
Cardiovascular System Tachycardia 39 (2.4)
Digestive System Nausea 89 (5.4) Vomiting 72 (4.4)
The most frequently reported adverse reactions in the adult therapeutic trials were visual disturbances (18.7%), fever (5.7%), nausea (5.4%), rash (5.3%), vomiting (4.4%), chills (3.7%), headache (3.0%), liver function test increased (2.7%), tachycardia (2.4%), and hallucinations (2.4%) 2.
The adverse reactions which most often led to discontinuation of voriconazole therapy were elevated liver function tests, rash, and visual disturbances 2.
Common side effects of Voriconazole include:
- Visual disturbances: abnormal vision, photophobia, chromatopsia
- Gastrointestinal symptoms: nausea, vomiting
- Fever
- Rash
- Chills
- Headache
- Liver function test increased
- Tachycardia
- Hallucinations It is essential to note that the FDA drug label provides a comprehensive list of potential side effects, and patients should be closely monitored for any adverse reactions during voriconazole therapy 2 2.
From the Research
Common Side Effects of Voriconazole
The common side effects of Voriconazole include:
- Transient visual disturbances, such as blurred vision, altered color perception, and photophobia 3, 4, 5, 6
- Liver enzyme abnormalities, such as elevated hepatic enzymes 3, 4, 5
- Skin rashes, including maculopapular rash and Stevens-Johnson syndrome 3, 4, 5
- Neurologic disturbances, such as hallucinations, encephalopathy, and peripheral neuropathy 4, 7, 6
- Cardiovascular events, such as cardiac complications 4
- Hematologic disorders, such as anemia and thrombocytopenia 4
- Renal disturbances, such as acute kidney injury 4
- Gastrointestinal disturbances, such as nausea, vomiting, and diarrhea 4, 5
- Alopecia and nail changes 7
- Hyponatremia 7
Less Common Side Effects
Less common side effects of Voriconazole include:
- Cutaneous malignancies, such as squamous cell carcinoma, which is associated with long-term use of the drug 7
- Periostitis 7
- Phototoxicity, which may be a precursor to malignancy 7
Special Considerations
It is essential to monitor serum voriconazole levels and adjust the dose accordingly to minimize the risk of adverse effects, especially in patients with hepatic dysfunction or those receiving medications that interact with voriconazole via hepatic metabolism 3, 5, 6. Additionally, guidelines for screening for adverse effects after long-term voriconazole use may be beneficial and need to be established 7.