Management of Voriconazole-Induced Liver Injury

Monitoring and Management

• For patients with mild to moderate liver enzyme elevations, the American Gastroenterological Association recommends continuing voriconazole at the current dose, increasing monitoring frequency to twice weekly, and evaluating for other causes of liver injury 1
• For patients with significant liver enzyme elevations, the Infectious Diseases Society of America suggests considering dose reduction based on therapeutic drug monitoring and increasing monitoring frequency to every 2-3 days 1
• In cases of severe liver enzyme elevations or clinical hepatitis, the Infectious Diseases Society of America recommends discontinuing voriconazole unless the medical judgment of benefit/risk justifies continued use, and considering alternative antifungal therapy such as an echinocandin 2
• The Infectious Diseases Society of America also recommends oral voriconazole dosage reduction for patients with mild to moderate hepatic impairment 2
• The American Gastroenterological Association suggests documenting the adverse event to inform future antifungal therapy decisions 1