Voriconazole

Restricted
C difficile risk
Low
Oral Bioavailability
Excellent

Dosing

eGFR 0 - 50 eGFR > 50 6mg/kg IV load and then STOP IV formulation
(IV therapy not recommended after first loading dose due to accumulation of cyclodextrin)

Continue course with 200mg PO q12hIV - 6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h

PO - 400mg PO q12h x 2 doses then 200mg PO q12h

Dose reduction may be required if low body weight

IV therapy not recommended after first loading dose due to accumulation of cyclodextrin.

Oral dosing does not require modification in renal failure.

400mg PO q12h x 2 doses then 200mg PO q12h

Severe impairment (Child-Pugh C)
Should only be used if benefit outweighs risk

Mild to moderate (Child-Pugh A/B)
Standard loading dose then reduce maintenance by 50%

PO - 400mg PO q12h x 2 doses then 200mg PO q12h

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

Dose reduction may be required if low body weight

Requires approval by Infectious Diseases

This antimicrobial is restricted to Infectious Diseases

General Information

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

Antifungal prophylaxis in immunocompromised patients.

Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (Discuss with ID).

QTc interval in patients at elevated risk.

Monitor hepatic profile.

  • Drug interactions

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash - up to 20%

  • Visual disturbance

  • Fluorosis

  •  GI upset

CYP450 interactions ++.

Other QTc prolonging agents.

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

Antimicrobial class: Triazole antifungal, Second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor