Available Stat

No

Performing Lab

China Basin Chemistry

Performed

Monday, Wednesday and Friday (excluding holidays)

In order to be run on Monday, Wednesday or Friday, samples have to be received by the lab by 5am that day.

Methodology

Liquid chromatography-tandem mass spectrometry (LC-MS/MS)

Reported

2-3 days

Additional Information

Voriconazole is a triazole antifungal agent. It has activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including Candida, Aspergillus, Scedosporium and Fusarium species.  

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19.  Substantial inter- and intra-patient variation in the voriconazole exposure is observed, likely due to greater metabolism of the drug by certain population groups, reduced metabolism by those with hepatic impairment, and co-administration of other drugs that increase or decrease the systemic concentration of voriconazole.   
Indications for voriconazole TDM
Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

Trough levels may also be obtained to investigate lack of response to therapy or for suspected toxicity.
 
Voriconazole start/change date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Order voriconazole trough level before evening dose on:  Tuesday or Thursday if start/change is late Sunday Thursday Thursday or Sunday if start/change is late Tuesday Sunday Sunday Sunday or Tuesday if start/change is late Friday Tuesday

 

Sample Type

Serum

Collect

Red top tube

Note: UCSF does not offer CSF testing. If required, this can be ordered as a MOLT from Quest.

Amount to Collect

2 mL blood

Preferred Volume

1 mL serum

Minimum Volume

0.3 mL serum

Remarks

Collect trough levels just before next dose. Peak levels:

IV: 15-30 minutes after end of infusion
IM: 45-60 minutes after injection
PO: 90 minutes after ingestion

Stability (from collection to initiation)

Refrigerated 3 months, frozen 2 years

Test Code

VORIC

Performing Lab

China Basin Chemistry

Specimen Preparation

Centrifuge blood and separate serum from cells as soon as possible. Keep sample refrigerated.

Preferred Volume

1 mL serum

Minimum Volume

0.3 mL serum

Stability (from collection to initiation)

Refrigerated 3 months, frozen 2 years

Units

µg/mL (mcg/mL)

Reference Interval

Target range:

Adults (≥ 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 2.0-6.0 µg/mL.

Pediatrics (< 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 1.0-5.5 µg/mL.


In adults, serum trough levels of >= 1.5-2.0 µg/mL are associated with greater likelihood of response in invasive fungal infections.

Serum trough levels of > 5.0-6.0 µg/mL have been reported to be associated with reversible neurological adverse events such as hallucinations and possibly hepatotoxicity.

For levels outside of the therapeutic range, consultation with ID or ID pharmacy is recommended.

Levels should be re-checked until a result in the therapeutic range is obtained, and after changes in doses/route/interacting drugs.  For patients on long-term voriconazole on stable doses, consider checking surveillance levels every 3 months.

References:
Ashbee HR et al. Therapeutic drug monitoring of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother 2014;69:1162-1176

Chau MM et al. Consensus guidelines for optimizing antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haemotological malignancy, 2014.  Inten Med Journal 2014;44:1364-1388

Lewis et al. Triazole antifungal therapeutic drug monitoring.  European Conference on Infections in Leukemia. 2015. 

Hamada et al. Practice Guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Journal of Infection and Chemotherapy. 2013; 19(3): 381-392.

Additional Information

Voriconazole is a triazole antifungal agent. It has activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including Candida, Aspergillus, Scedosporium and Fusarium species.  

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19.  Substantial inter- and intra-patient variation in the voriconazole exposure is observed, likely due to greater metabolism of the drug by certain population groups, reduced metabolism by those with hepatic impairment, and co-administration of other drugs that increase or decrease the systemic concentration of voriconazole.   
Indications for voriconazole TDM
Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

Trough levels may also be obtained to investigate lack of response to therapy or for suspected toxicity.
 
Voriconazole start/change date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Order voriconazole trough level before evening dose on:  Tuesday or Thursday if start/change is late Sunday Thursday Thursday or Sunday if start/change is late Tuesday Sunday Sunday Sunday or Tuesday if start/change is late Friday Tuesday

 

CPT Codes

80285

LDT or Modified FDA

Yes

Available Stat

No

Test Code

VORIC

Performing Lab

China Basin Chemistry

Performed

Monday, Wednesday and Friday (excluding holidays)

In order to be run on Monday, Wednesday or Friday, samples have to be received by the lab by 5am that day.

Methodology

Liquid chromatography-tandem mass spectrometry (LC-MS/MS)

Remarks

Collect trough levels just before next dose. Peak levels:

IV: 15-30 minutes after end of infusion
IM: 45-60 minutes after injection
PO: 90 minutes after ingestion

Collect

Red top tube

Note: UCSF does not offer CSF testing. If required, this can be ordered as a MOLT from Quest.

Amount to Collect

2 mL blood

Sample Type

Serum

Preferred Volume

1 mL serum

Minimum Volume

0.3 mL serum

Specimen Preparation

Centrifuge blood and separate serum from cells as soon as possible. Keep sample refrigerated.

Units

µg/mL (mcg/mL)

Reference Interval

Target range:

Adults (≥ 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 2.0-6.0 µg/mL.

Pediatrics (< 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 1.0-5.5 µg/mL.


In adults, serum trough levels of >= 1.5-2.0 µg/mL are associated with greater likelihood of response in invasive fungal infections.

Serum trough levels of > 5.0-6.0 µg/mL have been reported to be associated with reversible neurological adverse events such as hallucinations and possibly hepatotoxicity.

For levels outside of the therapeutic range, consultation with ID or ID pharmacy is recommended.

Levels should be re-checked until a result in the therapeutic range is obtained, and after changes in doses/route/interacting drugs.  For patients on long-term voriconazole on stable doses, consider checking surveillance levels every 3 months.

References:
Ashbee HR et al. Therapeutic drug monitoring of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother 2014;69:1162-1176

Chau MM et al. Consensus guidelines for optimizing antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haemotological malignancy, 2014.  Inten Med Journal 2014;44:1364-1388

Lewis et al. Triazole antifungal therapeutic drug monitoring.  European Conference on Infections in Leukemia. 2015. 

Hamada et al. Practice Guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Journal of Infection and Chemotherapy. 2013; 19(3): 381-392.

Stability (from collection to initiation)

Refrigerated 3 months, frozen 2 years

Reported

2-3 days

Additional Information

Voriconazole is a triazole antifungal agent. It has activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including Candida, Aspergillus, Scedosporium and Fusarium species.  

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19.  Substantial inter- and intra-patient variation in the voriconazole exposure is observed, likely due to greater metabolism of the drug by certain population groups, reduced metabolism by those with hepatic impairment, and co-administration of other drugs that increase or decrease the systemic concentration of voriconazole.   
Indications for voriconazole TDM
Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

Trough levels may also be obtained to investigate lack of response to therapy or for suspected toxicity.
 
Voriconazole start/change date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Order voriconazole trough level before evening dose on:  Tuesday or Thursday if start/change is late Sunday Thursday Thursday or Sunday if start/change is late Tuesday Sunday Sunday Sunday or Tuesday if start/change is late Friday Tuesday

 

CPT Codes

80285

LDT or Modified FDA

Yes
Ordering

Available Stat

No

Performing Lab

China Basin Chemistry

Performed

Monday, Wednesday and Friday (excluding holidays)

In order to be run on Monday, Wednesday or Friday, samples have to be received by the lab by 5am that day.

Methodology

Liquid chromatography-tandem mass spectrometry (LC-MS/MS)

Reported

2-3 days

Additional Information

Voriconazole is a triazole antifungal agent. It has activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including Candida, Aspergillus, Scedosporium and Fusarium species.  

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19.  Substantial inter- and intra-patient variation in the voriconazole exposure is observed, likely due to greater metabolism of the drug by certain population groups, reduced metabolism by those with hepatic impairment, and co-administration of other drugs that increase or decrease the systemic concentration of voriconazole.   
Indications for voriconazole TDM
Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

Trough levels may also be obtained to investigate lack of response to therapy or for suspected toxicity.
 
Voriconazole start/change date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Order voriconazole trough level before evening dose on:  Tuesday or Thursday if start/change is late Sunday Thursday Thursday or Sunday if start/change is late Tuesday Sunday Sunday Sunday or Tuesday if start/change is late Friday Tuesday

 
Collection

Sample Type

Serum

Collect

Red top tube

Note: UCSF does not offer CSF testing. If required, this can be ordered as a MOLT from Quest.

Amount to Collect

2 mL blood

Preferred Volume

1 mL serum

Minimum Volume

0.3 mL serum

Remarks

Collect trough levels just before next dose. Peak levels:

IV: 15-30 minutes after end of infusion
IM: 45-60 minutes after injection
PO: 90 minutes after ingestion

Stability (from collection to initiation)

Refrigerated 3 months, frozen 2 years
Processing

Test Code

VORIC

Performing Lab

China Basin Chemistry

Specimen Preparation

Centrifuge blood and separate serum from cells as soon as possible. Keep sample refrigerated.

Preferred Volume

1 mL serum

Minimum Volume

0.3 mL serum

Stability (from collection to initiation)

Refrigerated 3 months, frozen 2 years
Result Interpretation

Units

µg/mL (mcg/mL)

Reference Interval

Target range:

Adults (≥ 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 2.0-6.0 µg/mL.

Pediatrics (< 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 1.0-5.5 µg/mL.


In adults, serum trough levels of >= 1.5-2.0 µg/mL are associated with greater likelihood of response in invasive fungal infections.

Serum trough levels of > 5.0-6.0 µg/mL have been reported to be associated with reversible neurological adverse events such as hallucinations and possibly hepatotoxicity.

For levels outside of the therapeutic range, consultation with ID or ID pharmacy is recommended.

Levels should be re-checked until a result in the therapeutic range is obtained, and after changes in doses/route/interacting drugs.  For patients on long-term voriconazole on stable doses, consider checking surveillance levels every 3 months.

References:
Ashbee HR et al. Therapeutic drug monitoring of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother 2014;69:1162-1176

Chau MM et al. Consensus guidelines for optimizing antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haemotological malignancy, 2014.  Inten Med Journal 2014;44:1364-1388

Lewis et al. Triazole antifungal therapeutic drug monitoring.  European Conference on Infections in Leukemia. 2015. 

Hamada et al. Practice Guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Journal of Infection and Chemotherapy. 2013; 19(3): 381-392.

Additional Information

Voriconazole is a triazole antifungal agent. It has activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including Candida, Aspergillus, Scedosporium and Fusarium species.  

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19.  Substantial inter- and intra-patient variation in the voriconazole exposure is observed, likely due to greater metabolism of the drug by certain population groups, reduced metabolism by those with hepatic impairment, and co-administration of other drugs that increase or decrease the systemic concentration of voriconazole.   
Indications for voriconazole TDM
Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

Trough levels may also be obtained to investigate lack of response to therapy or for suspected toxicity.
 
Voriconazole start/change date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Order voriconazole trough level before evening dose on:  Tuesday or Thursday if start/change is late Sunday Thursday Thursday or Sunday if start/change is late Tuesday Sunday Sunday Sunday or Tuesday if start/change is late Friday Tuesday

 
Administrative

CPT Codes

80285

LDT or Modified FDA

Yes
Complete View

Available Stat

No

Test Code

VORIC

Performing Lab

China Basin Chemistry

Performed

Monday, Wednesday and Friday (excluding holidays)

In order to be run on Monday, Wednesday or Friday, samples have to be received by the lab by 5am that day.

Methodology

Liquid chromatography-tandem mass spectrometry (LC-MS/MS)

Remarks

Collect trough levels just before next dose. Peak levels:

IV: 15-30 minutes after end of infusion
IM: 45-60 minutes after injection
PO: 90 minutes after ingestion

Collect

Red top tube

Note: UCSF does not offer CSF testing. If required, this can be ordered as a MOLT from Quest.

Amount to Collect

2 mL blood

Sample Type

Serum

Preferred Volume

1 mL serum

Minimum Volume

0.3 mL serum

Specimen Preparation

Centrifuge blood and separate serum from cells as soon as possible. Keep sample refrigerated.

Units

µg/mL (mcg/mL)

Reference Interval

Target range:

Adults (≥ 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 2.0-6.0 µg/mL.

Pediatrics (< 18 years old)
Treatment/prophylaxis: steady-state trough range for most situations should be 1.0-5.5 µg/mL.


In adults, serum trough levels of >= 1.5-2.0 µg/mL are associated with greater likelihood of response in invasive fungal infections.

Serum trough levels of > 5.0-6.0 µg/mL have been reported to be associated with reversible neurological adverse events such as hallucinations and possibly hepatotoxicity.

For levels outside of the therapeutic range, consultation with ID or ID pharmacy is recommended.

Levels should be re-checked until a result in the therapeutic range is obtained, and after changes in doses/route/interacting drugs.  For patients on long-term voriconazole on stable doses, consider checking surveillance levels every 3 months.

References:
Ashbee HR et al. Therapeutic drug monitoring of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother 2014;69:1162-1176

Chau MM et al. Consensus guidelines for optimizing antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haemotological malignancy, 2014.  Inten Med Journal 2014;44:1364-1388

Lewis et al. Triazole antifungal therapeutic drug monitoring.  European Conference on Infections in Leukemia. 2015. 

Hamada et al. Practice Guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Journal of Infection and Chemotherapy. 2013; 19(3): 381-392.

Stability (from collection to initiation)

Refrigerated 3 months, frozen 2 years

Reported

2-3 days

Additional Information

Voriconazole is a triazole antifungal agent. It has activity against a broad spectrum of clinically significant fungal pathogens in immunocompromised patients, including Candida, Aspergillus, Scedosporium and Fusarium species.  

Voriconzaole is predominantly metabolized in the liver by the cytochrome P450 enzyme system, mainly by the isozyme CYP2C19.  Substantial inter- and intra-patient variation in the voriconazole exposure is observed, likely due to greater metabolism of the drug by certain population groups, reduced metabolism by those with hepatic impairment, and co-administration of other drugs that increase or decrease the systemic concentration of voriconazole.   
Indications for voriconazole TDM
Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

Trough levels may also be obtained to investigate lack of response to therapy or for suspected toxicity.
 
Voriconazole start/change date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Order voriconazole trough level before evening dose on:  Tuesday or Thursday if start/change is late Sunday Thursday Thursday or Sunday if start/change is late Tuesday Sunday Sunday Sunday or Tuesday if start/change is late Friday Tuesday

 

CPT Codes

80285

LDT or Modified FDA

Yes

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