Kato Hideo, Hagihara Mao, Hamada Yukihiro, Koizumi Yusuke, Nishiyama Naoya, Yamagishi Yuka, Matsuura Katsuhiko, Mikamo Hiroshige
Jpn J Antibiot. 2016 Sep;69(3):143-150.
Visual disturbance or central symptom like hallucination is well known to be one of the common drug adverse events in response to voriconazole (VRCZ). We observed 123 patients treated VRCZ from April 2012 to January 2016. Two of these cases experienced visual disturbance and 4 of these cases experienced central symptom. Six patients appeared visual disturbance or central symptom within 1 week after administration of VRCZ (visual disturbance; 3 days [2-42 days], central symptom; 6 days [3-9 days]) and disappeared visual disturbance or central symptom at an early date after discontinuation of administration or decreasing dose of VRCZ. The trough concentration of VRCZ in patients who experienced central symptom was similar with that in-patients who did not experience adverse events by VRCZ (case 3; 3.79μg/ mL, case 4; 1.28μg/mL vs 3.73μg/mL [0.09-13.27 μg/mL]). On the other hand, the trough concentration of VRCZ in patients who experienced visual disturbance was higher than that in patients who did not experience adverse events by VRCZ (case 5; 7.49μg/mL, case 6; 4.45μg/ mL vs 3.73μg/mL [0.09-13.27μg/mL]). In conclusion, we thought that the risk factor of visual disturbance was the increasing concentration of VRCZ. Therefore, we should monitor the onset of visual disturbance or central symptom in patients treated with VRCZ, especially central symptom that the concentration is unconcerned.
视觉障碍或幻觉等中枢症状是众所周知的伏立康唑（VRCZ）常见药物不良反应之一。我们观察了2012年4月至2016年1月期间接受VRCZ治疗的123例患者。其中2例出现视觉障碍，4例出现中枢症状。6例患者在使用VRCZ后1周内出现视觉障碍或中枢症状（视觉障碍；3天[2 - 42天]，中枢症状；6天[3 - 9天]），在停用VRCZ或降低剂量后，视觉障碍或中枢症状早期消失。出现中枢症状的患者中VRCZ的谷浓度与未出现VRCZ不良事件的患者相似（病例3；3.79μg/mL，病例4；1.28μg/mL对3.73μg/mL[0.09 - 13.27μg/mL]）。另一方面，出现视觉障碍的患者中VRCZ的谷浓度高于未出现VRCZ不良事件的患者（病例5；7.49μg/mL，病例6；4.45μg/mL对3.73μg/mL[0.09 - 13.27μg/mL]）。总之，我们认为视觉障碍的危险因素是VRCZ浓度升高。因此，我们应监测接受VRCZ治疗患者的视觉障碍或中枢症状的发生，尤其是对浓度无关的中枢症状。
