Clinical hepatotoxicity associated with antifungal agents

@article{Kyriakidis2016ClinicalHA,
  title={Clinical hepatotoxicity associated with antifungal agents},
  author={Ioannis Kyriakidis and Athanasios Tragiannidis and Silke Munchen and Andreas H. Groll},
  journal={Expert Opinion on Drug Safety},
  year={2016},
  volume={16},
  pages={149 - 165}
}
ABSTRACT Introduction: Invasive fungal diseases (IFDs) are a leading cause of morbidity and mortality among immunocompromised patients with bone marrow failure syndromes, hematological malignancies, hematopoietic stem cell transplantation (HSCT), those admitted in intensive care units (ICUs) and those with prolonged febrile neutropenia. IFDs occur in a setting of multiple morbidities and are associated with case fatality rates between 30 and 70%. Along with the development of classes and… 
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The present article reviews incidence, severity and mechanisms of nephrotoxicity associated with antifungal agents used for prevention and treatment of invasive fungal diseases by discussing distribution, metabolism, elimination and drug-related adverse events in the context of safety data from phase II and III clinical studies.

Adverse Effects Associated with Long-Term Administration of Azole Antifungal Agents

Azole antifungals are first-line options in the prophylaxis and treatment of invasive fungal infections and have been associated with peripheral neuropathies, and itraconazole and voriconazole with pancreatitis.

Hepatotoxicity Due to Azole Antimycotic Agents in a HLA B*35:02-Positive Patient

A 42-year-old woman with acute myeloid leukemia and pulmonary aspergillosis treated with several antifungal agents, including three triazoles is presented, which suggests a cross-toxicity, dose-dependency, and a possible genetic predisposition of triazole-induced liver injury.

Therapeutic drug monitoring for antifungal triazoles: pharmacologic background and current status

Posaconazole achieves prompt recovery of voriconazole-induced liver injury in a case of invasive aspergillosis

This case report provides further evidence that oral posaconazole is safe and effective as rescue therapy after the appearance of voriconazole-induced liver toxicity.

Therapeutic drug monitoring and safety evaluation of voriconazole in the treatment of pulmonary fungal diseases

Almost one-third of patients with pulmonary fungal disease needed to adjust their dose after the standard dose of voriconazole treatment, suggesting initial therapeutic drug monitoring (TDM) might predict the risk of hepatotoxicity.

Pre-Existing Liver Disease and Toxicity of Antifungals

This article provides suggestions for dosage adjustment of antifungal drugs in patients with varying degrees of hepatic impairment, after accounting for established or emerging pharmacokinetic–pharmacodynamic relationships with regard to antifundal drug efficacy in vivo.

Hepatic safety of the antifungal triazole agent posaconazole: characterization of adverse event reports in a manufacturer’s safety database

Use of concomitant medications with known risks for hepatic injury appears to be an important contributor for the development of hepatotoxicity in patients treated with posaconazole.

Management of bacterial and fungal infections in cirrhosis: The MDRO challenge.

Voriconazole-Induced Acute Liver Injury: A Case Report

A 61-year-old lady with a past medical history of sarcoidosis, stage IV and severe pulmonary hypertension initially admitted for the management of COVID pneumonia is reported, eventually culminating in mortality due to acute liver injury diagnosed was most probably related to voriconazole.
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