Not On Dialysis: PO Therapy (CrCl)
400 mg PO q12h x 2 doses, then 200-300 mg PO q12h May require dose adjustment if low body weight
No dose adjustment
Not On Dialysis: IV Therapy (CrCl)
6 mg/kg IV q12h x 2 doses, then 4 mg/kg IV q12h
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.