ArticleFrontiers in pharmacology2025
Unexpected voriconazole toxicity due to nirmatrelvir/ritonavir: a case report on drug-drug interaction and the role of therapeutic drug monitoring.
Article in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Voriconazole pseudotoxicity: a case report highlighting the importance of sampling timing in TDM interpretation by clinical pharmacists.Frontiers in medicine · 2026Article
- Plasma concentration of voriconazole under concomitant use of nirmatrelvir/ritonavir in patients with COVID-19: a multicenter retrospective study.Frontiers in pharmacology · 2025Article
- Real-World Analysis of Potential Drug-Drug Interactions with Nirmatrelvir/Ritonavir Based on the Hospital Prescription Analysis (HPA) Database in 9 Cities of China.Infection and drug resistance · 2025Article
- A case report of drug-drug interaction between voriconazole and simnotrelvir/ritonavir.Frontiers in antibiotics · 2025Article
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Authors and funding
6 authors.
Funding
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Abstract
Voriconazole is a triazole antifungal used for invasive fungal infections, particularly invasive aspergillosis. Its metabolism is primarily mediated by CYP2C19, with CYP3A4 and CYP2C9 also involved. Nirmatrelvir/ritonavir, an oral antiviral for COVID-19, inhibits CYP isoforms potentially altering the metabolism of co-administered drugs. We report a case of an immunosuppressed patient with SARS-CoV-2 pneumonia and invasive aspergillosis treated with voriconazole and nirmatrelvir/ritonavir. Unexpectedly, voriconazole plasma concentrations increased significantly (7.78 mg/L) instead of the anticipated decrease, leading to temporary discontinuation. Therapeutic drug monitoring (TDM) guided dose adjustments until optimal levels (2 mg/L) were achieved. After 13 days, the patient recovered from COVID-19, with clinical improvement of aspergillosis. This case highlights the importance of pharmacokinetic monitoring and drug-drug interaction assessment in critically ill patients.
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