Voriconazole
Renal

Renal

Not On Dialysis: PO Therapy (CrCl)

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

Not On Dialysis: IV Therapy (CrCl)

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.

Intermittent Hemodialysis

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

CVVHDF

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

Peritoneal Dialysis

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