C. diff Risk


Oral Bioavailability


Approximate Cost

IV: $$$$
Suspension: $$$$
Tablets: $$

Spectrum Of Activity


See drug monitoring information

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

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

Dose reduction may be required if low body weight, recommend using an adjusted body weight for obese patients

Oral bioavailability >95%. Consider initiating with/switching to oral therapy when patient tolerating oralsUse adjusted body weight for dosing

CrCl >50 mL/minCrCl <50 mL/minAdminister on an empty stomach.400 mg PO Q12h x 2 doses then 200 mg PO Q12h

  • In obese patients consider using a weight-based PO regimen (4mg/kg Q12h) using ABW

  • Consult ID/ID-pharmacy for assistance.

  • Voriconazole may require dose adjustment in hepatic dysfunction and has numerous drug interactions. Consult ID/ID-pharmacy for assistance.

CrCl >50 mL/minCrCl <50 mL/min6 mg/kg/dose IV q12h x 2 doses then 4 mg/kg/dose IV/PO q12h (ABW)Use of the IV formulation should be avoided if possible in patients with CrCl < 50 mL/min due to accumulation and renal toxicity.

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%

Loading Dose
6-9mg/kg/dose Q12H x2 doses, then

Maintenance Dose
4-9mg/kg/dose Q12H

No adjustment for renal dysfunctionThe IV formulation should be avoided if possible if CrCl<50mL/min due to the accumulation of the IV vehicle.Draw trough level ( ‚ȧ30 min before next dose) only after 5-7 days of treatment.

Loading Dose
400mg Q12H x2 doses, then

Maintenance Dose
200mg Q12H

  • Treatment of suspected/documented invasive aspergillosis.

  • For treatment of infections caused by S. apiospermum, Fusarium species (including F. solani) and non-albicans Candida species in patients intolerant of, or refractory to other therapy.

General Information

  • GI effects

  • Hepatitis

  • QT prolongation

  • Hypersensitivity

  • Transient visual disturbances

  • Cyclodextrin vehicle accumulation with IV formulation in patients with renal dysfunction (clinical significance of risk/benefit unknown)


  • ¬†Therapeutic drug monitoring should be done to ensure adequate concentrations and exclude toxicity (discuss with ID)

  • Baseline and periodic LFTs

  • Serum levels as indicated after 5-7 days at steady state (5-7 days). Target 2-5.5 for treatment, >1 for prophylaxis


  • GI effects

  • Prolongation of QT interval with risk factors

  • Hypersensitivity

  • Photosensitivity

  • Drug-drug interactions

  • Visual side effects

  • Hallucinations

CYP450 interactions ++

Other QTc prolonging agents

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

Please administer on an empty stomach

Antimicrobial class: Triazole antifungal, second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

ID consult advised

  • Aspergillosis

  • Oncologic neutropenic and BMT populations:

    • Definite (biopsy-proven) invasive non-zygomycete filamentous fungal infections
    • Probable invasive non-zygomycete filamentous fungal infections
    • Empiric therapy in patients with possible aspergillosis (follow-up diagnostic studied are highly recommended
  • Other patient populations:

    • Definite infections or as otherwise deemed appropriate after consultation with the Infectious Diseases service or the ASP
    • Pseudallescheria boydii (Scedosporim spp), Fusarium spp. Voriconazole is recommended as first-line therapy
    • Alternative therapy for C. krusei if susceptible and oral therapy is desired in stable patient.

  • Candidiasis / Neutropenic fever: Voriconazole should not be used as first-line therapy for the treatment of candidiasis or for empiric therapy in patients with neutropenic fever.

  • Treatment of positive urine cultures due to resistant Candida spp

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

Antifungal prophylaxis in immunocompromised