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We introduce dose\u2010dependent autoinduction of metabolism as another cause for altered voriconazole pharmacokinetics in children and summarize previously published literature on this phenomenon. A 10\u2010year\u2010old girl with severe aplastic anemia developed invasive pulmonary aspergillosis after high\u2010dose cyclophosphamide therapy and required high doses of voriconazole for longer than 2\u00a0months. She initially achieved a therapeutic trough of 1.4\u00a0\u03bcg\/ml on voriconazole 11\u00a0mg\/kg\/dose orally every 12\u00a0hours but required dose escalations to 9.3\u00a0mg\/kg\/dose orally every 8\u00a0hours to maintain a trough above 1\u00a0\u03bcg\/ml. Because there were no changes in concomitant medications, route of administration, adherence, or oral intake, we conclude that the only plausible explanation for the precipitous drop in voriconazole troughs was autoinduction of metabolism, a phenomenon previously reported in adults receiving higher than usual doses or prolonged courses (longer than 2\u00a0months). These data highlight the need for continued therapeutic drug monitoring of voriconazole after initial therapeutic troughs are achieved because autoinduction of metabolism can lead to significant declines in subsequent voriconazole troughs, potentially leading to treatment failure.<\/jats:p>","DOI":"10.1002\/phar.1566","type":"journal-article","created":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T07:37:30Z","timestamp":1429256250000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Autoinduction of Voriconazole Metabolism in a Child with Invasive Pulmonary Aspergillosis"],"prefix":"10.1002","volume":"35","author":[{"given":"Alice Jenh","family":"Hsu","sequence":"first","affiliation":[{"name":"Division of Pediatric Pharmacy Department of Pharmacy The Johns Hopkins Hospital Baltimore 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