As a broad-spectrum antifungal drug, voriconazole (Vfend) has multiple systemic reactions such as visual abnormalities and liver function damage, which require targeted relief through dose adjustment, adjuvant therapy, and monitoring methods. In particular, attention should be paid to the risks of photosensitive reactions and drug interactions.

1. Common side effects and alleviation

(1) Visual impairment

About 30% of patients experience flash hallucinations, color vision changes, or blurred vision, which are usually transient. It is recommended to avoid driving at night and stop taking medication for evaluation if the symptoms persist for more than 24 hours.

(2) Abnormal liver function

The incidence of elevated transaminase is about 15%. Liver function should be monitored weekly before and during treatment. If AST/ALT>5 times the upper limit, medication should be stopped and liver protective drugs should be used if necessary.

2. Serious Adverse Reaction Management

(1) Photosensitive reaction

Manifesting as severe sunburn like dermatitis, physical sun protection measures should be taken to avoid UV exposure. If skin burns or blisters occur, the medication should be permanently discontinued.

(2) Arrhythmia

Patients at risk of QT interval prolongation should undergo baseline electrocardiogram examination to avoid the use of other drugs that can cause QT prolongation. Electrolyte imbalances should be corrected in a timely manner.

3. Protection for special populations

(1) Child patients

The risk of abnormal bone development increases, and it is necessary to strictly limit the course of treatment, regularly monitor bone age and growth rate, and supplement vitamin D and calcium supplements.

(2) Liver and kidney dysfunction

Child Pugh A/B grade patients should reduce their dosage by 50% and creatinine clearance rate<50ml/min. Oral preparations are prohibited, and dosage supplementation is required after hemodialysis.

4. Drug interaction prevention

(1) CYP450 inhibitors

Avoid using strong CYP3A4 inhibitors such as ritonavir in combination. When using cyclosporine in combination, monitor the latter's blood concentration and reduce it by 50%.

(2) Enzyme inducer

Rifampicin can reduce the AUC of voriconazole by 90%, and when it must be used in combination, other antifungal regimens should be switched or monitoring frequency adjusted.