Voriconazole

C difficile risk
Low
Oral Bioavailability
Excellent

Dosing

IV – All indications (use IBW)PO – Severe DiseasePO – Mild/Moderate Disease6 mg/kg q12h x 2 doses, then 4 mg/kg q12h- <40kg: 150 mg PO q12h

  • ≥40 kg: 300 mg PO q12h

  • <40kg: 100 mg PO q12h

  • ≥40 kg: 200 mg PO q12h

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%

CrCl 0 - 50 CrCl > 50 IV not recommended due to accumulation of cyclodextrin. If used, closely monitor Scr and change to PO ASAPUsual dosing

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

Oral dosing does not require modification in renal failure.

General Information

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

Antifungal prophylaxis in immunocompromised patients.

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

Many significant drug interactions, including CYP450 interactions. Medications should be reviewed carefully before voriconazole is used.

Antimicrobial class: Triazole antifungal, Second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

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