Voriconazole - Renal Dosing

50+ mL/min

400 mg PO q12h x 2 doses, then 200-300 mg PO q12h
May require dose adjustment if low body weight

0 - 50 mL/min

No dose adjustment

50+ mL/min

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

0 - 50 mL/min

6 mg/kg IV q12h x 2 doses, then 4 mg/kg IV q12h
Switch to oral formulation as soon as feasible.
IV voriconazole contains cyclodextrin which can accumulate and cause toxicity.

IV therapy not recommended after first loading dose due to accumulation of cyclodextrin.
Oral dosing does not require modification in renal failure.

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

IV therapy not recommended after first loading dose due to accumulation of cyclodextrin.
Oral dosing does not require modification in renal failure.