Postoperative delirium or side effects of voriconazole: pharmacist’s viewpoint

A 78-year-old Han Chinese woman (height 150 cm, weight 55 kg) underwent left knee prosthesis revision and developed an infection during hospitalisation. Subsequently, the patient developed restlessness and hallucinations. A consultation by a psychiatrist diagnosed postoperative delirium, whereas a clinical pharmacist attributed these symptoms to voriconazole-related adverse effects. The patient had an inadequate response to delirium-targeted treatments, and a voriconazole concentration of 5.0 mg/L was measured. Following the pharmacist's recommendation to discontinue the drug, the symptoms resolved within 4 days. The adverse effects were classified as 'possible' according to the Naranjo Adverse Drug Reaction Probability Scale. To our knowledge, this is the first case highlighting the divergent perspectives between specialist physicians and clinical pharmacists during consultations.