NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Voriconazole adverse effects

Voriconazole is licensed for invasive aspergillosis and is on the Formulary for specialist use only. In May 2014, the MHRA highlighted the additional risk of phototoxicity and skin squamous cell carcinoma associated with voriconazole. It is important that GPs are also aware of these risks as patients with symptoms may present initially in primary care. GPs should consider adding this to their practice systems if a patient is prescribed it from hospital.

 

These severe adverse events have been reported with long term treatment. The duration of therapy should be as short as possible and treatment of more than 6 months should only be considered if benefits outweigh potential risks.

 

Prescribers should:

  • Advise all patients (including children) to avoid intense or prolonged exposure to direct sunlight during voriconazole treatment.
  • Advise patients to use measures such as protective clothing and high factor sun screen.
  • Advise patients to report phototoxic reactions.
  • Seek consultation from a dermatologist if phototoxic reactions occur, and consider discontinuation of voriconazole.
  • Perform dermatologic evaluation on a regular basis.
  • Discontinue voriconazole if premalignant skin lesions or skin squamous cell  carcinoma is identified

 

More information on prescribing voriconazole safely can be found in a previous article here. A patient alert card about dermatological side effects and evaluation is available from Pfizer.