The effect of enteral nutrition supplements on serum voriconazole levels

This is the case of a 13-year-old Hispanic boy (34.2 kg, 1.14 m²) who had achieved stable therapeutic levels on voriconazole who later experienced levels reported as ‘none detected’ after the initiation of tube feeds. This case outlines the temporal relationship of the effect of tube feeds on voriconazole serum levels. Based on this information, voriconazole suspension should not be prescribed to patients also receiving supplemental enteral nutrition. In absence of formal animal or human pharmacokinetic studies, it is the recommendation of the author to separate this combination and to be very vigilant about checking serum voriconazole levels in patients on voriconazole suspension and enteral nutrition supplements.