{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:36:37Z","timestamp":1760146597260,"version":"build-2065373602"},"reference-count":14,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T00:00:00Z","timestamp":1732233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union NextGenerationEU","award":["#BG-RRP-2.004-0003-C01"],"award-info":[{"award-number":["#BG-RRP-2.004-0003-C01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Voriconazole is a commonly prescribed second-generation azole used for the prevention and treatment of fungal infections. This report seeks to elucidate the relationship between certain intravenous infusion parameters and the causality and severity of potential visual adverse events associated with voriconazole administration, despite existing reports of visual disturbances such as hallucinations and altered visual perception, the underlying causes of which remain inadequately understood. Case Presentation: This case report describes a 32-year-old female patient who experienced sudden hallucinations and visual impairments after receiving an initial dose of intravenous voriconazole for the treatment of recurrent severe vulvovaginitis caused by Candida glabrata. The symptoms quickly disappeared when the dosage and infusion rate were reduced as per the recommendations of the clinical pharmacist. Conclusions: This example emphasizes the possible negative drug responses linked to voriconazole, especially those provoked by its irrational use described as an inappropriate infusion rate, and the crucial role of clinical pharmacists in recognizing and handling these reactions.<\/jats:p>","DOI":"10.3390\/reports7040105","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T06:41:48Z","timestamp":1732257708000},"page":"105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cCrocus Flower\u201d: Voriconazole-Induced Hallucinations and Visual Disturbances in a Patient with Recurrent Severe Vulvovaginitis\u2014A Case Report on Irrational Drug Use"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6165-5674","authenticated-orcid":false,"given":"Svetoslav","family":"Stoev","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Sciences and Social Pharmacy, Faculty of Pharmacy, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4835-6965","authenticated-orcid":false,"given":"Hristina","family":"Lebanova","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences and Social Pharmacy, Faculty of Pharmacy, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/FPC.0000000000000276","article-title":"PharmGKB summary: Voriconazole pathway, pharmacokinetics","volume":"27","author":"Barbarino","year":"2017","journal-title":"Pharmacogenet. Genom."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_3","first-page":"7823","article-title":"Toxic optic neuropathy due to voriconazole: Possible potentiation by reduction of CYP2C19 activity","volume":"25","author":"Orssaud","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/cpt.583","article-title":"Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C19 and Voriconazole Therapy","volume":"102","author":"Moriyama","year":"2017","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s001090050253","article-title":"Glucose-6-phosphate dehydrogenase deficiency and malaria","volume":"76","author":"Ruwende","year":"1998","journal-title":"J. Mol. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kato, H., Shiraishi, C., Hagihara, M., Mikamo, H., and Iwamoto, T. (2024). Association between voriconazole-induced visual hallucination and dopamine in an analysis of the food and drug administration (FDA) adverse event reporting system database. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-63504-y"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1086\/588844","article-title":"Hallucinations during voriconazole therapy","volume":"47","author":"Zonios","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zheng, R., Li, Y., Guo, C., Pei, Y., Ke, Z., and Huang, L. (2021). Voriconazole Induced Hallucinations and Visual Disturbances in a Female Child: A Case Report and Literature Review. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.655327"},{"key":"ref_9","unstructured":"Kato, H., Hagihara, M., Hamada, Y., Koizumi, Y., Nishiyama, N., Yamagishi, Y., Matsuura, K., and Mikamo, H. (2016). Visual disturbance or central symptom like hallucination in patients treated voriconazole: Report of six cases. Jpn. J. Antibiot., 69."},{"key":"ref_10","first-page":"660","article-title":"An investigation of visual hallucinations associated with voriconazole administration to patients with hematological malignancies","volume":"71","author":"Sakurada","year":"2016","journal-title":"Pharmazie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3109\/15569527.2015.1020544","article-title":"Voriconazole-associated visual disturbances and hallucinations","volume":"35","author":"Bayhan","year":"2015","journal-title":"Cutan. Ocul. Toxicol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ling, J., Yang, X., Dong, L., Jiang, Y., Zou, S., and Hu, N. (2024). Influence of C-reactive protein on the pharmacokinetics of voriconazole in relation to the CYP2C19 genotype: A population pharmacokinetics analysis. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1455721"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s13318-019-00603-6","article-title":"Effect of Gender and Age on Voriconazole Trough Concentrations in Italian Adult Patients","volume":"45","author":"Allegra","year":"2020","journal-title":"Eur. J. Drug Metab. Pharmacokinet."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tilen, R., Paioni, P., Goetschi, A.N., Goers, R., Seibert, I., M\u00fcller, D., Bielicki, J.A., Berger, C., Kr\u00e4mer, S.D., and Meyer zu Schwabedissen, H.E. (2022). Pharmacogenetic Analysis of Voriconazole Treatment in Children. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14061289"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/4\/105\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:37:30Z","timestamp":1760114250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/4\/105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,22]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["reports7040105"],"URL":"https:\/\/doi.org\/10.3390\/reports7040105","relation":{},"ISSN":["2571-841X"],"issn-type":[{"type":"electronic","value":"2571-841X"}],"subject":[],"published":{"date-parts":[[2024,11,22]]}}}