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Voriconazole

Item Value
Test Update Information Effective 6/16/2014, voriconazole testing will be performed in-house at China Basin Chemistry using LC-MS/MS.

The results of this method are approximately 11% higher than the results from Focus Diagnostics (via Quest)
Approval req'd? No
Available Stat? No
Test code VORIC
Performed by China Basin Chemistry
Sendout? Yes
In House Availability Tuesday and Friday AM (excluding holidays)
Method Liquid chromatography-tandem mass spectrometry (LC-MS/MS)
Collection Instructions Collect trough levels just before next dose. Peak levels:
IV 15-30 minutes after end of infusion
IM 45-60 minutes after injection
PO 90 minutes after ingestion
Container type Red top tube (Gold top NOT acceptable)

Note: UCSF does not offer CSF testing. If required this can be ordered as a MOLT test from Quest.
Amount to Collect
Blood 2 mL
Sample type Serum
Preferred volume 1 mL serum
Min. Volume 0.3 mL serum
UCSF Rejection Criteria Collected in Gold top.
Processing notes Centrifuge blood and separate serum from cells as soon as possible. Keep sample refrigerated.
Ref Lab Rejection Criteria Received thawed.
Units µg/mL (mcg/mL)
Normal range Achievable steady state levels with typical dosing range from 2.0-6.0 µg/mL.

Serum trough levels of ≤ 1.0 µg/mL are reported to be associated with lack of therapeutic response.
Serum trough levels of > 6.0 µg/mL have been reported to be associated with reversible neurological adverse events and hepatotoxicity.

References:
Hamada et al. Practice Guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Journal of Infection and Chemotherapy. 2013; 19(3): 381-392.

Pascual et al. Challenging recommended oral and intravenous voriconazole doses for improved efficacy and safety: Population pharmacokinetics-based analysis of adult patients with invasive fungal infections. Clinical Infectious Diseases. 2012; 55(3): 381-390.
Stability Refrigerated 3 months, frozen 2 years
Turn around times 3-4 days
Additional information Voriconazole is a new second-generation triazole antifungal agent. It has been shown to have 10-500 times more potent activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including fluconazole-resistant Candida and Aspergillus species, as well as emerging fungal pathogens, such as Scedosporium and Fusarium species, which may be resistant to itraconazole, fluconazole, and amphotericin B.

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19. Because of a genetic disposition towards a greater metabolism of the drug by certain population groups, a less effective metabolism by those with hepatic impairment, and because co-administration of other drugs may function to increase or decrease the systemic concentration of voriconazole, it may be clinically helpful to assay the serum/plasma level of voriconazole.
CPT coding 80299-90
LDT or Mod FDA? Yes
Last Updated 5/20/2014 11:49 AM
Entry Number 1378
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