Voriconazole - Renal Dosing

In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.

If improving renal function, actual CrCl is likely higher than calculated CrCl.

If worsening renal function, actual CrCl is likely lower than calculated CrCl.

eGFR > 50

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

eGFR 0 - 50

6mg/kg IV load and then STOP IV formulation

Continue course with 200mg PO q12h

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

Oral dosing does not require modification in renal failure.

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