Pharmacology and clinical use of voriconazole.

IMPORTANCE OF THE FIELD: Voriconazole is an extended-spectrum triazole developed specifically to target Aspergillus spp. and is now indicated as primary therapy in this circumstance. However, it has a broad spectrum of activity against both yeasts and molds and is also a viable treatment option in the treatment of other mycoses. AREAS COVERED IN THIS REVIEW: This review discusses the mechanism of action, the pharmacodynamics and pharmacokinetics and the most common mechanisms of resistance to this agent. An overview of therapeutic drug monitoring, drug-drug interactions and pivotal trials are also reviewed. WHAT THE READER WILL GAIN: The reader will gain further knowledge of the unique aspects of voriconazole compared to other currently available antifungal agents. TAKE HOME MESSAGE: Voriconazole offers distinct advantages over several other antifungals. The side effect profile of voriconazole is unique compared to other triazole agents. Concern for drug-drug interactions due to a frequently shared common metabolic pathway has prompted heightened interest in the use of therapeutic drug monitoring for concerns of toxicity, drug-drug interactions and in attempts to ensure efficacy. These aspects as well as a review of important clinical information pertaining to voriconazole are discussed here.