{"hq_id":"hq-c-org-002110","name":"Voriconazole","context":"human_adult","risk_level":"moderate","schema":"legacy","note":"Synthesis unavailable: compound lacks vectorizable regulatory classifications. Raw safety data returned.","data":{"risk_level":"moderate","summary":"Voriconazole is a second-generation triazole antifungal and the current first-line treatment for invasive aspergillosis (Herbrecht et al. 2002 landmark trial: voriconazole superior to amphotericin B). Broad spectrum: active against Aspergillus, Candida (including fluconazole-resistant strains), Fusarium, and Scedosporium. Notable gap: NO activity against Mucorales (mucormycosis). Mechanism: CYP51 inhibition. Distinctive adverse effects: transient visual disturbances in ~30% of patients (photopsia, color vision changes, blurred vision) — caused by retinal CYP51 inhibition; these resolve on discontinuation. Phototoxicity is a major concern with prolonged use: severe sunburn, actinic keratoses, and squamous cell carcinoma of the skin (FDA warning 2016) — patients on long-term voriconazole require sun protection and dermatological monitoring. Hepatotoxicity: elevated transaminases in 10-20%, serious hepatitis rare. Pharmacogenomics: CYP2C19 polymorphisms dramatically affect drug levels — ultra-rapid metabolizers may have subtherapeutic levels; poor metabolizers (common in Asia, 15-20%) have 4x higher levels with increased toxicity risk. Therapeutic drug monitoring (TDM) recommended (target trough: 1-5.5 ug/mL).","source_refs":["aletheia_fungi_batch_2026"]},"meta":{"synthesis_version":"n/a","timestamp":"2026-07-27T03:42:48.573Z"},"_notice":"ALETHEIA output is reference data, not professional advice. Not a substitute for primary agency sources or qualified professionals. See https://aletheia.holisticquality.io/disclaimer.","_disclaimer_url":"https://aletheia.holisticquality.io/disclaimer","available_contexts":["human_adult"]}