Which specific cytochrome P450 enzyme is cited for causing significant individual variability in Voriconazole metabolism?
Answer
CYP2C19.
The primary challenge in achieving consistent drug levels of voriconazole stems from its extensive metabolism by the liver's cytochrome P450 (CYP) enzyme system. While CYP2C9 and CYP3A4 are also involved, the text highlights that genetic differences in the expression of the CYP2C19 enzyme are responsible for leading to vast individual variability in how quickly or slowly a patient processes the drug. Some individuals may be rapid metabolizers, leading to sub-therapeutic drug levels, while others are slow metabolizers, risking toxic accumulation. This genetic polymorphism in CYP2C19 metabolism necessitates close monitoring to adjust dosing appropriately for efficacy and safety.
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