{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:55:00Z","timestamp":1792601700182,"version":"4.5.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Optimization of antifungal therapy with voriconazole can be challenging due to inter- and intrapatient variability in voriconazole pharmacokinetics (PK). In this case, we introduce challenges in voriconazole therapy due to drug\u2013drug interactions, autoinduction, and saturable metabolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary:<\/jats:title>\n                    <jats:p>A 32-year-old male on chronic prednisone developed central nervous system (CNS) aspergillosis. He was started on high-dose intravenous (IV) voriconazole 8.5 mg\/kg every 12 hours due to concerns for lasting induction effects of recent rifampin therapy. The initial voriconazole trough was 2 \u03bcg\/mL. Frequent dose adjustments were made to maintain the therapeutic trough goal. On day 24 of voriconazole therapy, his trough was undetectable on IV voriconazole 5.5 mg\/kg every 12 hours. His dose was escalated to 8.5 mg\/kg every 12 hours to avoid subtherapeutic levels and therapeutic failure. On day 48, his trough level was 1.1 \u03bcg\/mL on the same dose. His regimen was changed to 6.5 mg\/kg every 8 hours at this point. Sixteen days after this regimen on day 74 of voriconazole therapy, his trough was 27.2 \u03bcg\/mL indicating saturable PK of voriconazole in the absence of interacting drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our findings highlight the unpredictable PK of voriconazole and reinforce the importance of continuous therapeutic drug monitoring in critically ill patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0897190018760621","type":"journal-article","created":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T20:50:26Z","timestamp":1519937426000},"page":"589-594","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Voriconazole Autoinduction and Saturable Metabolism After Cessation of Rifampin in a Patient With Invasive Central Nervous System Aspergillus: Importance of Therapeutic Drug Monitoring"],"prefix":"10.1177","volume":"32","author":[{"given":"Salia","family":"Farrokh","sequence":"first","affiliation":[{"name":"Neuro Intensive Care, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edina","family":"Avdic","sequence":"additional","affiliation":[{"name":"Antimicrobial Stewardship Program, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"key":"bibr1-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410180511"},{"key":"bibr2-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198205000-00004"},{"key":"bibr3-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-197003000-00002"},{"key":"bibr4-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1086\/324620"},{"key":"bibr5-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw444"},{"key":"bibr6-0897190018760621","unstructured":"Vfend (voriconazole) [package insert]. New York, NY: Pfizer; 2002."},{"key":"bibr7-0897190018760621","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200645070-00002"},{"key":"bibr8-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23109"},{"key":"bibr9-0897190018760621","doi-asserted-by":"publisher","DOI":"10.7326\/M13-2508"},{"key":"bibr10-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1177\/0091270008327537"},{"key":"bibr11-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1086\/598327"},{"key":"bibr12-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-016-0416-1"},{"key":"bibr13-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.8.2546-2553.2002"},{"key":"bibr14-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02830-15"},{"key":"bibr15-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw349"},{"key":"bibr16-0897190018760621","unstructured":"FDA Antiviral Drugs Advisory Committee. Briefing document for voriconazole (oral and intravenous formulations). 2001. www.fda.gov\/ohrms\/dockets\/ac\/01\/briefing\/3792b2_01_Pfizer.pd. Accessed May 10, 2017."},{"key":"bibr17-0897190018760621","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200342090-00003"},{"key":"bibr18-0897190018760621","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200140050-00002"},{"key":"bibr19-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.31.6.731"},{"key":"bibr20-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2007.07.019"},{"key":"bibr21-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01221-08"},{"key":"bibr22-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1016\/j.mmcr.2013.04.001"},{"key":"bibr23-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12199"},{"key":"bibr24-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1566"},{"key":"bibr25-0897190018760621","doi-asserted-by":"publisher","DOI":"10.2147\/DHPS.S140213"},{"key":"bibr26-0897190018760621","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01558-13"},{"key":"bibr27-0897190018760621","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00568"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190018760621","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0897190018760621","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190018760621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:34:53Z","timestamp":1777509293000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0897190018760621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,1]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1177\/0897190018760621"],"URL":"https:\/\/doi.org\/10.1177\/0897190018760621","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,1]]}}}