Sakurada H, Yasuhara K, Kato K, Asano S, Yoshida M, Yamamura M, Tachi T, Teramachi H
Pharmazie. 2016 Nov 2;71(11):660-664. doi: 10.1691/ph.2016.6725.
Voriconazole (VRCZ) is commonly administered to treat fungal infections in patients with hematological malignancies. Some of these patients experience VRCZ-associated visual hallucinations. We conducted a retrospective survey to investigate the characteristic features of this side effect. Patients with hematological malignancies who were treated with VRCZ for a fungal infection after hospitalization at Ichinomiya municipal hospital between 1 October 2005 and 31 December 2015 were included in this study (n = 103). Fifteen of these (14.6%) reported visual hallucinations that started on day 1-7. Seven of these 15 patients developed this symptom rapidly (day 1 or 2). Three patients had transient symptoms (lasting 2-12 days), 6 patients experienced hallucinations throughout the treatment, and the duration was unknown in 6 patients. Eleven patients experienced visual hallucinations when their eyes were closed (73 %) and these disappeared when they opened their eyes. One patient had visual hallucinations with open eyes, while the state of the eyes was unknown in 3 patients. The patients saw a range of images including people, animals, landscapes, and foods; several reported seeing images like those found in movies. In addition, 9 of 15 patients (60%) with visual hallucinations had visual disturbances. This was a higher proportion than that observed in patients who did not develop hallucinations (17 of 88; 19.3 %; P < 0.05). However, we found no significant difference between the blood VCRZ concentrations of patients who developed or did not develop visual hallucinations. This study indicated that most of these patients had visual hallucinations that manifested on eye closure, and they did not progress to serious mental illness. Our findings emphasized the importance of fully explaining the features of this symptom to each patient prior to starting VRCZ administration in order to reduce anxiety. In addition, since VRCZ discontinuation will compromise patient management, therapeutic drug monitoring should be used to increase the likelihood of successful therapy.
伏立康唑（VRCZ）常用于治疗血液系统恶性肿瘤患者的真菌感染。其中一些患者会出现与VRCZ相关的视幻觉。我们进行了一项回顾性调查，以研究这种副作用的特征。本研究纳入了2005年10月1日至2015年12月31日期间在一宫市立医院住院后接受VRCZ治疗真菌感染的血液系统恶性肿瘤患者（n = 103）。其中15例（14.6%）报告在第1 - 7天开始出现视幻觉。这15例患者中有7例症状出现迅速（第1天或第2天）。3例患者有短暂症状（持续2 - 12天），6例患者在整个治疗过程中都有幻觉，6例患者的持续时间未知。11例患者闭眼时出现视幻觉（73%），睁眼时幻觉消失。1例患者睁眼时有视幻觉，3例患者的眼睛状态未知。患者看到的图像范围包括人、动物、风景和食物；有几例报告看到的图像类似于电影中的图像。此外，15例有视幻觉的患者中有9例（60%）有视觉障碍。这一比例高于未出现幻觉的患者（88例中的17例；19.3%；P < 0.05）。然而，我们发现出现或未出现视幻觉的患者血液中VCRZ浓度之间没有显著差异。本研究表明，这些患者中的大多数视幻觉在闭眼时出现，且未发展为严重精神疾病。我们的研究结果强调了在开始使用VRCZ治疗前向每位患者充分解释这种症状特征的重要性，以减轻焦虑。此外，由于停用VRCZ会影响患者管理，应使用治疗药物监测来提高治疗成功的可能性。
