Antimicrobials
Voriconazole

Voriconazole

Restricted

Low
Excellent

Spectrum of Activity

Dosing

General Information

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

Antifungal prophylaxis in immunocompromised

Pregnancy:

  • Single case report in human pregnancy (after 19 wga), normal healthy baby.
  • Animal data suggest teratogenicity.
  • Caution due to data from fluconazole (see fluconazole entry).

Breastfeeding:

  • No data. 
  • References conflicting on recommendations. 
  • While limited, therapeutic dosing available for neonates and infants for invasive fungal infections.

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+)

  • QTc prolongation
  • Hepatotoxicity, renal toxicity
  • Rash; dermatologic reactions
  • Visual disturbance, photophobia, headache, dizziness,
  •  Fluorosis
  • Hypokalemia, hypomagnesemia

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