Antimicrobials
Voriconazole

Voriconazole

C difficile risk
Low
Oral Bioavailability
Excellent
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%

0 - 50 50+ 6mg/kg IV load and then STOP IV formulation 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

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

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