TDM | The "Protective Umbrella" for Patients with Inflammation!

Severe infections are commonly seen in hospitalized patients, particularly in patients in ICUs. The risk of infection even seems to increase with longer admission to an ICU. Additionally, the incidence of severe sepsis continues to increase.
Multiple in vitro and in vivo studies have shown that during an infection or inflammation several drug-metabolizing enzymes in the liver are downregulated, including cytochrome P450 (CYP) iso-enzymes. This can result in reduced metabolism of drugs that are metabolized by these enzymes and hence higher drug concentrations, of which voriconazole is one. In this regard, the University Medical Center of Groningen in the Netherlands conducted a prospective study on the impact of inflammation on voriconazole metabolism and voriconazole trough concentrations, as follows:

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Study population: patients aged 18 years and receiving voriconazole treatment, excluded if the patient also used strong inhibitor or inducer of CYP3A4 (36 patients met the inclusion criteria. 2 patients were excluded because serum concentrations were not measured at steady state) .

 Sample source:discarded blood sample

Detection of target substances: concentration of voriconazole & voriconazole-N-oxide


Inflammation indicator: C-reactive protein (CRP)


Study purpose: Prospectively explore the effect of inflammation on voriconazole metabolism and voriconazole trough concentration


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Data analysis: Thirty-four patients were included. In total 489 voriconazole trough concentrations were included in the longitudinal data analysis. This analysis showed that inflammation, reflected by CRP concentrations, significantly influenced the metabolic ratio, voriconazole trough concentration and voriconazole-N-oxide concentration (all P,0.001), when corrected for other factors that could influence voriconazole metabolism. The metabolic ratio was decreased by 0.99229N and the voriconazole-N-oxide concentration by 0.99775N, while the voriconazole trough concentration was increased by 1.005321N, where N is the difference in CRP units (in mg/L).


Conclusions: This study shows that voriconazole metabolism is decreased during inflammation, resulting in higher voriconazole trough concentrations. Therefore, frequent monitoring of voriconazole serum concentrations is recommended during and following severe inflammation.

Diagreat product solutions

Based on the chemiluminescence platform, Diagreat Biotech provides a monitoring and testing package for blood concentration of inflammation & anti-infective drugs (see table below). Based on the above-mentioned prospective studies, the combined use of the two can effectively avoid adverse consequences in patients such as slowed metabolism and increased concentration of voriconazole caused by inflammation. In addition to blood drug concentration monitoring of anti-infective drugs, we can also provide multiple series of blood drug concentration monitoring packages for immunosuppressive drugs, antipsychotic drugs, anti-tumor drugs, cardiac glycoside drugs, anti-asthmatic drugs, etc. (see table below). Diagreat chemiluminescence detection instruments have the characteristics of high degree of automation, fast testing speed, large detection throughput, stable operation, superior performance, and perfect traceability, etc., and can provide complete solutions for users at different levels

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