A single center experience of hepatotoxicity of 7 mg/kg dose of voriconazole administration in a pediatric hematology-oncology center

Background: The newer antifungal drugs were related to have fewer side effects such as infusion related problems and nephrotoxicity. However hepatotoxicity due to antifungal drugs had been more increasingly reported with a wide spectrum changing from asymptomatic abnormalities in liver function test results to potentially fatal fulminant hepatic failure Methods: This study was designed and conducted as a retrospective study of immunocompromised pediatric patients to whom voriconazole was administered for proven or probable invasive fungal infections, between January 2008-December 2011. The alanine aminotransferase (ALT), total bilirubin levels and hemogram with absolute neutrophil count were recorded. Results: A total of 60 patients with 90 probable and possible invasive aspergillus infection were enrolled in this study. Among the 90 episodes of voriconazole therapy; six patients (6,6%) had increased ALT levels (116 to 416 u/L). Rest of them had normal levels of ALT during the 21 day period. The mean duration of the day that the ALT increased was 9th ± 5,0 day (ranging from 3th days to 15th days). The median duration of the hepatotoxicity was 6 days, ranging from 6 to 22 days. Only one patient had increased direct bilirubin levels. Conclusion: Hepatotoxicity due to 7 mg/kg/dose twice a day of voriconazole treatment is very low even with the long duration of exposure; and discontinuation of the drug in children may not be required in case of invasive aspergillus infections.