Adverse Neurologic Events Associated with Voriconazole Use in 3 Cats

Background: Voriconazole has a broader spectrum of activity in comparison to fluconazole, itraconazole, and amphotericin B. Little documentation regarding appropriate dosing, efficacy, or adverse effects exists for cats. Neurologic adverse effects have been reported as a result of administration in other species. Hypothesis: Voriconazole administration resulted in neurologic abnormalities in 3 cats. Animals: Three cats that received voriconazole. Methods: Observational study of adverse effects associated with voriconazole administration. Results: All 3 cats had ataxia, which in 2 cats progressed to paraplegia of the rear limbs. Two of the cats had visual abnormalities including mydriasis, decreased to absent pupillary light responses, and decreased menace response. Arrhythmia and hypokalemia were noted in 2 separate cats. Conclusions and Clinical Importance: Voriconazole has potential neurologic adverse effects in cats. Additional information regarding pharmacokinetics of the drug in this species must be gathered to help determine how it can be dosed most effectively with minimal adverse effects.