CLINICAL TRIALS AND OBSERVATIONS Reversible skeletal disease and high fluoride serum levels in hematologic patients receiving voriconazole
نویسندگان
چکیده
We here investigate the occurrence of fluoride intake-associated alterations in patients with hematologic disease on triazol antifungal medication. Clinical, laboratory, and radiology data of overall 43 patients with hematologic malignancies taking voriconazole (n 20), posaconazole (n 8), and itraconazole (n 4), and a hematologic patient control group (n 11) are described. Bone pain and radiologic evidence of periostitis were exclusively observed in patients receiving long-term voriconazole. Cessation of treatment led to clinical improvement in all cases. In line with clinical evidence, fluoride serum concentration was elevated in patients receiving voriconazole (median, 156.5 g/L; interquartile range, 96.8 g/L; normal < 30 g/L) but not in the other treatment groups (P < .001 for all comparisons vs voriconazole). We conclude that serum fluoride levels were elevated on average 5-fold above normal levels in hematologic patients receiving voriconazole. Clinically relevant skeletal disease was associated with renal insufficiency and above 10-fold elevated fluoride levels, and was reversible on termination of voriconazole treatment. (Blood. 2012; 120(12):2390-2394)
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