Antimicrobials
Voriconazole

Voriconazole

Low
Excellent
IV: $$$$ Suspension: $$$$ Tablets: $$

Spectrum of Activity

General Information

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.
  • 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

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

Antifungal prophylaxis in immunocompromised

Laboratory

  • Therapeutic drug monitoring should be done to ensure adequate concentrations and exclude toxicity (discuss with ID)
  • Baseline and periodic LFTs
  • Serum levels no earlier than 5-7 days. Time to reach steady state highly variable (>/=14 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
  • 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)

CYP450 interactions ++

Other QTc prolonging agents

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

Please administer on an empty stomach

Antimicrobial class: Triazole antifungal, second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor