Voriconazole
Renal

Renal

In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.

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

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

Not On Dialysis

eGFR 0 - 50

6 mg/kg IV load and then STOP IV formulation

Continue course with 200mg PO q12h

eGFR > 50

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

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

Dose reduction may be required if low body weight

Intermittent Dialysis

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

Oral dosing does not require modification in renal failure

Continuous Dialysis

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