Voriconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

IV-$300 PO-$100

Dosing

Adult

See drug monitoring information.

IV - 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.

Hepatic

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%

General Information

Common Usage

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

Antifungal prophylaxis in immunocompromised.

Drug Monitoring

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.

Adverse Effects

  • Drug interactions

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash - up to 20%

  • Visual disturbance

  • Fluorosis

  •  GI upset

Major Interactions

CYP450 interactions ++.

Other QTc prolonging agents.

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

Pharmacology

Antimicrobial class: Triazole antifungal, second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor