Mild to moderate (Child-Pugh class A or B)
Standard loading dose then reduce maintenance dose by 50%
Severe impairment (Child-Pugh class C)
Should only be used if benefit outweighs risk. Monitor closely for toxicity.
Non-formulary at MSH.
Candida infections both mucocutaneous and invasive - i.e. Candidemia.
Antifungal prophylaxis in immunocompromised patients.
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (Discuss with ID). When voriconazole is taken concomitantly with other drugs, dose adjustment of voriconazole or the concomitant drug may be required due to drug interactions.
QTc interval in patients at elevated risk.
Monitor hepatic profile.
Infusion related effects: tachycardia, dyspnea, fever, flushing.
Hepatic enzyme abnormalities
Rash - up to 20%
CYP450 interactions ++.
Other QTc prolonging agents.
Recommend review of pt medications due to high frequency of significant interactions.
Antimicrobial class: Triazole antifungal, Second generation
Pregnancy category: D
Average serum half life: Variable, dose-dependent. Steady-state is achieved by day 3 when an IV loading dose is administered and between days 5 and 8 if no loading dose is used (Purkins 2003).
Urine penetration: Poor
Lung penetration: Therapeutic
CSF penetration: Therapeutic