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Candida infections both mucocutaneous and invasive - i.e. Candidemia
Antifungal prophylaxis in immunocompromised
Pregnancy:
Breastfeeding:
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity
QTc interval in patients at elevated risk
Monitor hepatic profile
Creatinine, electrolytes (K+, Mag+, Ca+)
CYP450 interactions ++
Other QTc prolonging agents
Contraindicated with pimozide, quiniDINE, rifampin, carbamazepine, sirolimus, rifabutin, ritonavir, efavirenz, ergot alkaloids, and phenobarbital
Voriconazole may inhibit the metabolism of tacrolimus (need to decrease tacrolimus dose to 1/3 of original dose), cycloSPORINE (need to decrease cycloSPORINE dose by 50%), sulphonylureas, statins, and HIV protease inhibitors other than indinavir
Voriconazole increases concentration of phenytoin. Phenytoin decreases concentration of voriconazole. Drug monitoring recommended.
Recommend review of patient medications due to high frequency of significant interactions
Food may decrease oral absorption. Should be taken 1hr before or 1 hr after a meal
Avoid/limit use of IV formulation in renal failure due to accumulation of vehicle (cyclodextrin)
Requires ID or Antimicrobial Stewardship approval for onging use without an accepted indication
Antimicrobial class: Triazole antifungal, second generation
Average serum half life: Variable
CSF penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Poor