Antimicrobials
Voriconazole

Voriconazole

Restricted

Low
Excellent
IV: $ PO: $$

Spectrum of Activity

General Information

See Restricted Antimicrobials Approved Indications of Use

  • Invasive Aspergillosis

Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (Discuss with ID). When voriconazole is taken concomitantly with other drugs, dose adjustment of voriconazole or the concomitant drug may be required due to drug interactions.

QTc interval in patients at elevated risk.

Monitor hepatic profile.

Please see attached for guidance on dose timing and actionable steps.

  • Infusion related effects: tachycardia, dyspnea, fever, flushing
  • QTc prolongation
  • Hepatic enzyme abnormalities, hepatic injury
  • Rash - up to 20%
  • Visual disturbance (high trough concentration)
  • Periostitis
  • Fluorosis
  • GI upset
  • CNS effects (Hallucinations, Encephalopathy)

CYP450 interactions ++.

Other QTc prolonging agents.

Recommend review of patient medications due to high frequency of significant interactions. Consult pharmacy.

LU code for outpatient use:

  • LU 399 Outpatient continuation of treatment documented invasive aspergillosis in patients who have demonstrated a clinical response to either oral or parenteral voriconazole
  • The first prescription MUST be written by a physician based at the hospital where the patient was hospitalized
  • Limited to 3 months of reimbursement
  • Authorization Period: 1 year

Antimicrobial class: Triazole antifungal, Second generation

Pregnancy category: D

Average serum half life: Variable, dose-dependent Steady state is achieved by Day 3 when an IV loading dose is administered and between days 5 and 8 if no loading dose is given

CSF penetration: Therapeutic (>50%)

Lung penetration: Therapeutic

Urine penetration: Poor

Vitreous penetration: Therapeutic (>50%)