PDF(Pubmed)
Abstract：
Voriconazole is a second-generation azole used to treat serious fungal infections. Visual hallucinations constitute a representative adverse event caused by voriconazole. However, its mechanism of action remains unclear. In patients with schizophrenia or Parkinson\'s disease, the frequency of visual hallucinations is associated with brain dopamine levels. This study investigated the frequency of visual hallucinations in patients treated with voriconazole alone or in combination with dopaminergic medicines or dopamine antagonists, using data collected from the Food and Drug Administration Adverse event Reporting System (FAERS). The frequency of visual hallucinations with voriconazole alone and in combination with a dopaminergic medicine (levodopa) or dopamine antagonists (risperidone and chlorpromazine) was compared using data from the FAERS between 2004 and 2023, using the reporting odds ratio (ROR) with relevant 95% confidence intervals (CI). The reference group comprised patients who had been administered voriconazole without dopaminergic medication or dopamine antagonists. Of the patients, 22,839, 90,810, 109,757, 6,435, 20, 83, and 26, respectively were treated with voriconazole, levodopa, risperidone, chlorpromazine, voriconazole plus levodopa, voriconazole plus risperidone, and voriconazole plus chlorpromazine. The occurrence of visual hallucinations increased when used in combination with levodopa (ROR = 12.302, 95% CI = 3.587-42.183). No increase in incidence was associated with the concomitant use of dopamine antagonists (risperidone, ROR = 1.721, 95% CI = 0.421-7.030; chlorpromazine, ROR = none, 95% CI = none). Dopaminergic medicine may increase the risk of visual hallucinations in patients treated with voriconazole. Whether voriconazole positively modulates dopamine production warrants further investigation using a translational research approach.
摘要：
伏立康唑是用于治疗严重真菌感染的第二代唑。视觉幻觉是由伏立康唑引起的代表性不良事件。然而,其作用机制尚不清楚。在精神分裂症或帕金森病患者中，视觉幻觉的频率与大脑多巴胺水平有关。这项研究调查了单独使用伏立康唑或与多巴胺能药物或多巴胺拮抗剂联合治疗的患者的视觉幻觉频率，使用从食品和药物管理局不良事件报告系统（FAERS）收集的数据。使用2004年至2023年FAERS的数据，使用报告优势比（ROR）与相关的95％置信区间（CI），比较了单独使用伏立康唑以及与多巴胺能药物（左旋多巴）或多巴胺拮抗剂（利培酮和氯丙嗪）联合使用的视觉幻觉频率。参照组包括在没有多巴胺能药物或多巴胺拮抗剂的情况下服用伏立康唑的患者。在患者中，分别用伏立康唑治疗22,839、90,810、109,757、6,435、20、83和26，左旋多巴,利培酮,氯丙嗪,伏立康唑加左旋多巴,伏立康唑加利培酮,和伏立康唑加氯丙嗪.与左旋多巴联合使用时，视觉幻觉的发生率增加（ROR=12.302，95％CI=3.587-42.183）。发病率没有增加与伴随使用多巴胺拮抗剂（利培酮，ROR=1.721，95%CI=0.421-7.030；氯丙嗪，ROR=无,95%CI=无)。多巴胺能药物可能会增加使用伏立康唑治疗的患者发生幻觉的风险。伏立康唑是否积极调节多巴胺的产生值得使用转化研究方法进一步研究。
