Voriconazole - Renal - Adult Dosing

Oral bioavailability >95%. Consider initiating with/switching to oral therapy when patient tolerating orals

Use adjusted body weight for dosing

Administer on an empty stomach.

CrCl >50 mL/min

400 mg PO Q12h x 2 doses then 200 mg PO Q12h

  • In obese patients consider using a weight-based PO regimen (4mg/kg Q12h) using ABW

  • Consult ID/ID-pharmacy for assistance.

CrCl <50 mL/min
  • Voriconazole may require dose adjustment in hepatic dysfunction and has numerous drug interactions. Consult ID/ID-pharmacy for assistance.
CrCl >50 mL/min

6 mg/kg/dose IV q12h x 2 doses then 4 mg/kg/dose IV/PO q12h (ABW)

CrCl <50 mL/min

Use of the IV formulation should be avoided if possible in patients with CrCl < 50 mL/min due to accumulation and renal toxicity.