Antimicrobials
Voriconazole

Voriconazole

N/A
Excellent (90 to 100%)
IV: $27.24/dose; PO: $18.16/dose

Spectrum of Activity

General Information

  • Therapeutic drug monitoring

  • QTc

  • LFTs

  • Acute kidney injury

  • QTc prolongation

  • Photosensitivity

  • Alopecia

  • Skin reactions, including TEN and DRESS

  • Hepatotoxicity

  • Visual disturbances

  • Optic neuritis, color changes

  • Peripheral neuropathy

  • Encephalopathy

  • Periosteal disease

  • Hyperkalemia

See Lexicomp; significant drug-drug interactions

Obtain a trough level after 5-7 days of therapy. “Misc lab - voriconazole”

  • Distribution: 
    • Extensive tissue distribution
    • CSF concentration ~50% of plasma concentration
    • Vd: 4.6 L/kg
  • Protein Binding: 58%
  • Metabolism: Hepatic, via CYP2C19 (major pathway) and CYP2C9 and CYP3A4; saturable
  • Bioavailability: 96%
  • Half-Life Elimination: 
    • 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 used
  • Time to Peak: Oral: 1-2 hours
  • Excretion: Urine (<2% as unchanged drug)