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Clin Pharmacol Ther. 2017 Jul;102(1):45-51. doi: 10.1002/cpt.583. Epub 2017 Apr 18.

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C19 and Voriconazole Therapy.

Author information

1
National Institutes of Health Clinical Center Pharmacy Department, Bethesda, Maryland, USA.
2
The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
3
Department of Pharmacy, The Mount Sinai Hospital, New York, New York, USA.
4
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
5
Department of Genetics, Stanford University, Stanford, California, USA.
6
Department of Pharmacotherapy, University of North Texas, System College of Pharmacy, Fort Worth, Texas, USA.
7
Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
8
Department of Pharmacology, University of Extremadura, Cáceres, Spain.
9
University of Florida College of Medicine, Gainesville, Florida, USA.
10
DeBartolo Family Personalized Medicine Institute, Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida, USA.
11
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
12
Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, Tennessee, USA.
13
Transplantation-Oncology Infectious Diseases Program, Departments of Medicine, Pediatrics, and Microbiology and Infectious Diseases, Weill Cornell Medical Center of Cornell University, New York, New York, USA.

Abstract

Voriconazole, a triazole antifungal agent, demonstrates wide interpatient variability in serum concentrations, due in part to variant CYP2C19 alleles. Individuals who are CYP2C19 ultrarapid metabolizers have decreased trough voriconazole concentrations, delaying achievement of target blood concentrations; whereas poor metabolizers have increased trough concentrations and are at increased risk of adverse drug events. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for the use of voriconazole for treatment based on CYP2C19 genotype (updates at https://cpicpgx.org/guidelines/ and www.pharmgkb.org).

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