Antimicrobials

Voriconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

IV-$300 PO-$100

Dosing

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.

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

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

Antifungal prophylaxis in immunocompromised.

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