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Invasive Aspergillosis — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsInvasive AspergillosisSCE Infectious Diseases

A 40-year-old renal transplant recipient on Tacrolimus develops invasive pulmonary aspergillosis confirmed by tissue biopsy. Voriconazole is the preferred antifungal. What is the most important drug interaction to manage?

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Correct answer: E — Voriconazole inhibits CYP3A4 and markedly increases Tacrolimus levels

Voriconazole is a potent inhibitor of CYP3A4, CYP2C9, and CYP2C19. It dramatically increases Tacrolimus levels (typically 3-fold or more), risking severe nephrotoxicity and neurotoxicity. When initiating Voriconazole, Tacrolimus dose should be reduced by approximately one-third to one-half, with frequent therapeutic drug monitoring of both drugs. Voriconazole itself requires TDM (target trough 1–5.5 mg/L).

Reference: BNF 2024 – Drug interactions: Voriconazole; BSAC 2022 – Antifungal guidelines