伏立康唑主要由 CYP2C19 和 CYP3A4 代谢。影响该途径的药物相互作用可以改变其血浆暴露量，从而导致伏立康唑浓度不达标。在本病例报告中，我们描述了一名 64 岁男性的病例，他因非霍奇金淋巴瘤接受持续糖皮质激素联合治疗伏立康唑对抗侵袭性肺曲霉病。在携带 CYP2C19 *1*2 基因型的患者中观察到伏立康唑的谷浓度 (Cmin) 降低，这与同时服用地塞米松有关：伏立康唑 Cmin/剂量比为 0.018 (0.1 mg L-1/5.7 mg kg-) 1 day-1)、0.18 (1 mg L-1/5.7 mg kg-1 day-1) 和 0.23 (2 mg L-1/8.6 mg kg-1 day-1)，地塞米松剂量为 20、12.5、和 2.5 毫克，分别。亚治疗伏立康唑 Cmin 与高剂量和中剂量地塞米松（20 和 12.5 mg）相关，导致抗真菌治疗失败。伏立康唑-地塞米松相互作用的程度由地塞米松的剂量决定，并与 CYP2C19 相关*1 *2 基因型。伏立康唑的治疗药物监测对于避免临床相关相互作用以实现最佳抗真菌治疗是必要的。版权所有 © 2024 Huang、Chen、Zhong 和 Tan。

Voriconazole is primarily metabolized by CYP2C19 and CYP3A4. Drug interactions that affect this pathway can alter its plasma exposures, resulting in untargeted voriconazole concentrations.In this case report, we describe the case of a 64-year-old man who was treated for non-Hodgkin's lymphoma with continuous glucocorticoids co-administrated with voriconazole against invasive pulmonary aspergillosis. A decrease in trough concentration (Cmin) of voriconazole was observed and related with co-administration of dexamethasone in the patient carrying the CYP2C19 *1*2 genotype: voriconazole Cmin/dose ratios of 0.018 (0.1 mg L-1/5.7 mg kg-1 day-1), 0.18 (1 mg L-1/5.7 mg kg-1 day-1), and 0.23 (2 mg L-1/8.6 mg kg-1 day-1) at dexamethasone doses of 20, 12.5, and 2.5 mg, respectively. Sub-therapeutic voriconazole Cmin was associated with high- and moderate-dose dexamethasone (20 and 12.5 mg), leading to failure of antifungal treatment.The extent of voriconazole-dexamethasone interaction was determined by the dose of dexamethasone and associated with the CYP2C19 *1*2 genotype. Therapeutic drug monitoring of voriconazole is necessary to avoid clinically relevant interactions for optimal antifungal therapy.Copyright © 2024 Huang, Chen, Zhong and Tan.