Voriconazole Hepatotoxicity: Risks, Signs, and What to Do

When you take voriconazole, a powerful antifungal used to treat serious fungal infections like invasive aspergillosis. Also known as Vfend, it saves lives—but it can also harm your liver. This isn’t rare. Studies show up to 20% of people on long-term voriconazole develop signs of liver stress, and in some cases, it leads to severe drug-induced liver injury, damage caused by medications rather than viruses or alcohol. Your liver doesn’t scream when it’s under stress. It whispers—through fatigue, dark urine, or yellowing eyes—and if you miss those signs, the damage can grow.

Not everyone gets liver trouble on voriconazole, but some groups are more at risk. Older adults, people with pre-existing liver disease, and those taking other medications that affect the liver—like anticoagulants, blood thinners such as warfarin that can compound liver strain.—need extra monitoring. Even something as simple as a high-fat meal can change how your body processes voriconazole, pushing liver enzyme levels higher. That’s why doctors check your liver enzymes before you start, then every week or two during treatment. If ALT or AST levels jump more than three times the normal limit, they’ll pause the drug. No waiting. No hoping it gets better. This isn’t guesswork—it’s standard safety protocol.

You might feel fine while taking voriconazole, but that doesn’t mean your liver is. That’s why tracking symptoms matters more than how you feel. Nausea, loss of appetite, or unexplained itching? Don’t brush it off. These aren’t just "side effects"—they’re red flags. And if you’re on other drugs that stress the liver—like certain antibiotics, seizure meds, or even herbal supplements like garlic supplements, which can interfere with liver metabolism and increase bleeding or toxicity risks.—your risk goes up fast. The key isn’t avoiding voriconazole when you need it. It’s knowing how to use it safely. That’s why your care team will ask you to report every odd symptom, no matter how small.

Below, you’ll find real-world advice from people who’ve been there—how to spot early warning signs, what labs to ask for, how to talk to your pharmacist about interactions, and what to do if your liver enzymes start climbing. These aren’t theoretical guidelines. They’re lessons from patients, doctors, and pharmacists who’ve seen what happens when liver damage isn’t caught in time. You’re not alone in this. But you do need to be alert.