ID
Age, Sex
Underlying diagnosis
Antifungal 1 & dose prior to switch
Indication for antifungal therapy
Maximal LFT abnormalities; ≥ULN or patient’s baseline Maximal LFT abnormalities; ≥ULN or patient’s baseline
CTCAE grade prior to switch a
Antifungal 2 & starting dose
Indication for switch
LFT results post switch; ≥ULN or patients’ baseline
LFT results post switch; ≥ULN or patients’ baseline
Time to improvement of LFT results post switch
Naranjo score b
Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole Voriconazole switch to fluconazole
1
4.2y M
Chronic granulomatous disease (HSCT)
Voriconazole 15.4mg/kg oral BD
Possible fungal infection
ALT GGT x4.1 x18.3 2 3 Fluconazole 7.3mg/kg oral OD
Drug-related hepatotoxicity
ALT GGT normalised normalised End of therapy (15 weeks)
4
2
13.4y M
Acute myeloid leukemia (induction), acute appendicitis
Voriconazole 12.8mg/kg oral BD
Fungal prophylaxis
GGT
x12.9
3
Fluconazole 11.8mg/kg oral OD
None given
GGT
x7.2
End of therapy (1-week)
6
3
7.5y M
Acute myeloid leukemia (HSCT)
Voriconazole 10.0mg/kg oral BD
Fungal prophylaxis
ALT GGT x5.0 x15.5 2 3 Fluconazole 9.1mg/kg OD
Drug related hepatotoxicity
ALT GGT x2.6 x1.1 End of therapy (1-week)
7
Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole Fluconazole switch to voriconazole
4
16.6y F
Blastic plasmacytoid dendritic cell neoplasm (HSCT)
Fluconazole 4.7mg/kg oral OD
Fungal prophylaxis
GGT
x8.3
3
Voriconazole 2.3mg/kg oral BD
Febrile neutropenia - antifungal prophylaxis
GGT
normalised
End of therapy (8 weeks)
3
5
7.0y M
X-linked Hyper-IgM syndrome (HSCT)
Fluconazole 8.4mg/kg IV OD
Fungal prophylaxis
ALT GGT x3.5 x6.8 2 3 Voriconazole 9.0mg/kg IV BD
Febrile neutropenia - treatment of possible infection
ALT GGT x1.4 x3.6 End of therapy (<1 week)
2
Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole Voriconazole switch to itraconazole
6
5.7y M
T-cell acute lymphoblastic leukemia, febrile neutropenia
Voriconazole 7.5mg/kg oral BD
Fungal prophylaxis
GGT
x4.8
2
Itraconazole (2.5mg/kg oral twice a day)
Drug related hepatotoxicity
GGT
x3.0
1-2 weeks
5
Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole Posaconazole switch to voriconazole
7
15.0y M
Acute myeloid leukemia relapse (HSCT)
Posaconazole MR 4.3mg/kg OD 5 days/week & 5.8mg/kg OD 2 days/week
Fungal prophylaxis
GGT
x2.8
2
Fluconazole 5.8mg/kg IV daily
Pre-HSCT, potential drug interactions
GGT
x1.1
1-2 weeks
3