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Voriconazole is a triazole antifungal that contains three fluoride atoms. A heart transplant recipient recently developed periostitis, including multiple painful exostoses, after taking this medication for several months. Laboratory testing revealed elevated serum and bone alkaline phosphatase levels, as well as elevated plasma and bone fluoride levels. Within 1 month after the patient's voriconazole was changed to itraconazole, her pain improved. At 2 months, her serum alkaline phosphatase level had declined by 50%, and, at 3 months, her plasma fluoride levels had also decreased.
To determine whether voriconazole treatment might be a cause of fluoride excess, researchers compared 10 transplant recipients who had received 400 mg of voriconaz…