Voriconazole, Fluoride Levels, and Periostitis

In a retrospective review of 28 patients with bone pain while on voriconazole, plasma fluoride levels were significantly elevated in those showing bone-scan evidence of periostitis.

Because of its excellent oral bioavailability and central nervous system penetration, voriconazole is recommended for a variety of fungal infections. However, voriconazole is trifluorinated, and the recommended maintenance dose of 400 mg daily contains 65 mg of fluoride — 15 times more than the recommended daily intake. Periostitis, skeletal fluorosis, and exostoses have all been reported in association with voriconazole therapy and have been attributed to excess fluoride intake.

To test this hypothesis, researchers conducted a retrospective review involving patients at a Michigan hospital who received voriconazole to treat fungal infections acquired from contaminated methylprednisolone acetate injections. Twenty-eight of the 195 patients re…

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Voriconazole, Fluoride Levels, and Periostitis

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Reviewing Author