Voriconazole

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

IV: $$$$
Suspension: $$$$
Tablets: $$

Dosing

Adult

See drug monitoring information

IV Dosing
6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h

PO Dosing
400mg PO q12h x 2 doses then 200mg PO q12h

Dose reduction may be required if low body weight, recommend using an adjusted body weight for obese patients

Hepatic

Severe impairment (Child-Pugh C)
Should only be used if benefit outweighs risk

Mild to moderate (Child-Pugh A/B)
Standard loading dose then reduce maintenance by 50%

Restricted Use

  • Treatment of suspected/documented invasive aspergillosis.

  • For treatment of infections caused by S. apiospermum, Fusarium species (including F. solani) and non-albicans Candida species in patients intolerant of, or refractory to other therapy.

General Information

Acceptable Uses

ID consult advised

  • Aspergillosis

  • Oncologic neutropenic and BMT populations:

    • Definite (biopsy-proven) invasive non-zygomycete filamentous fungal infections
    • Probable invasive non-zygomycete filamentous fungal infections
    • Empiric therapy in patients with possible aspergillosis (follow-up diagnostic studied are highly recommended
  • Other patient populations:

    • Definite infections or as otherwise deemed appropriate after consultation with the Infectious Diseases service or the ASP
    • Pseudallescheria boydii (Scedosporim spp), Fusarium spp. Voriconazole is recommended as first-line therapy
    • Alternative therapy for C. krusei if susceptible and oral therapy is desired in stable patient.

Unacceptable Uses

  • Candidiasis / Neutropenic fever: Voriconazole should not be used as first-line therapy for the treatment of candidiasis or for empiric therapy in patients with neutropenic fever.

  • Treatment of positive urine cultures due to resistant Candida spp

Common Usage

Candida infections both mucocutaneous and invasive - i.e. Candidemia

Antifungal prophylaxis in immunocompromised

Drug Monitoring

Laboratory

  • ┬áTherapeutic drug monitoring should be done to ensure adequate concentrations and exclude toxicity (discuss with ID)

  • Baseline and periodic LFTs

  • Serum levels as indicated after 5-7 days at steady state (5-7 days). Target 2-5.5 for treatment, >1 for prophylaxis

Clinical

  • GI effects

  • Prolongation of QT interval with risk factors

  • Hypersensitivity

  • Photosensitivity

  • Drug-drug interactions

  • Visual side effects

  • Hallucinations

Adverse Effects

  • GI effects

  • Hepatitis

  • QT prolongation

  • Hypersensitivity

  • Transient visual disturbances

  • Cyclodextrin vehicle accumulation with IV formulation in patients with renal dysfunction (clinical significance of risk/benefit unknown)

Major Interactions

CYP450 interactions ++

Other QTc prolonging agents

Recommend review of pt medications due to high frequency of significant interactions

Additional Information

Please administer on an empty stomach

Pharmacology

Antimicrobial class: Triazole antifungal, second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor