Antimicrobials
Voriconazole

Voriconazole

Restricted
C difficile risk
Low
Oral Bioavailability
Excellent (90 to 100%)

Dosing

400 mg PO BID, or 

6 mg/kg IV q12h x 2 doses, then 200 mg PO BID, or 

4 mg/kg IV q12h (reduce dose by 50% for less than 40 kg)

IVUse ideal body weight or adjusted body weight

Should only be used if benefit outweighs risk

Standard loading dose then reduce maintenance by 50%

Renal Impairment * No change for oral dose * If CrCl less than 50: DO NOT administer IV due to cyclodextrin accumulation

No change for oral dose

DO NOT administer IV due to cyclodextrin accumulation

General Information

Restricted to prophylaxis or treatment of aspergillus OR scedosporium OR fusarium OR in patients intolerant to or isolate resistant to amphotericin B deoxycholate or fluconazole.

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

Urine penetration: Poor

Lung penetration: Therapeutic

CSF penetration: Therapeutic