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Test Code VORI Voriconazole, Serum

Reporting Name

Voriconazole, S

Useful For

Monitoring trough levels of voriconazole suggested for:

-Individuals with reduced liver function

-Individuals with cytochrome P450 (CYP) 2C19 alterations associated with poor metabolic function

-Patients taking other medications that affect CYP2C19 activity

-Patients experiencing potential toxicity

 

Monitoring trough levels in patients who are not responding optimally or have drug interactions that may decrease voriconazole levels or to ensure adequate oral absorption

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum Red


Specimen Required


Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube: Red top (serum gel/SST not acceptable)

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

Collection Instructions: Within 2 hours of collection, centrifuge and aliquot serum into a plastic vial.


Specimen Minimum Volume

0.6 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Red Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Reference Values

1.0-5.5 mcg/mL

Trough level (ie, immediately before next dose) monitoring is recommended.

Day(s) Performed

Monday through Saturday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

80285

LOINC Code Information

Test ID Test Order Name Order LOINC Value
VORI Voriconazole, S 38370-3

 

Result ID Test Result Name Result LOINC Value
88698 Voriconazole, S 38370-3

Interpretation

Trough levels above 6 mcg/mL (and especially >10 mcg/mL) have been associated with toxicity in several reports.

 

Trough levels below 1 mcg/mL have been associated with suboptimal response in several reports.

Clinical Reference

1. Andes D, Pascual A, Marchetti O. Antifungal therapeutic drug monitoring: established and emerging indications. Antimicrob Agents Chemother. 2009;53(1):24-34. doi:10.1128/AAC.00705-08

2. Hope WW, Billaud EM, Lestner J, Denning DW. Therapeutic drug monitoring for triazoles. Curr Opin Infect Dis. 2008;21(6):580-586. doi:10.1097/QCO.0b013e3283184611

3. Wilson JW, Estes LL, eds: Mayo Clinic Antimicrobial Therapy: Quick Guide. 2nd ed. Oxford University Press; 2011

4. Donnelly JP, De Pauw BE. Voriconazole-a new therapeutic agent with an extended spectrum of antifungal activity. Clin Microbiol Infect.  2004;10 Suppl 1:107-117. doi:10.1111/j.1470-9465.2004.00838.x

5. Physicians Desk Reference, (PDR) 60th edition. Medical Economics Company, 2006 update to 2008

6. Brunton LL, ed: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill Book Company; 2006

7. Luong ML, Al-Dabbagh M, Groll AH, et al. Utility of voriconazole therapeutic drug monitoring: a meta-analysis. J Antimicrob Chemother. 2016;71(7):1786-1799. doi:10.1093/jac/dkw099

Report Available

Same day/1 to 2 days

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)