Voriconazole

C difficile risk
Low
Oral Bioavailability
Excellent
Cost
IV $125/day PO $4/day

Dosing

Defined criteria for use and/or important safety considerations. See below for more information.

Obesity: use ideal or adjusted body weight. Consider using adjusted body weight in patients with life threatening infection and adequate hepatic function.

CrCl > 50 mL/min6 mg/kg IV q12h x 2 doses, then 4 mg/kg IV q12h

Weight ≥ 40 kgWeight < 40 kg400 mg PO q12h x 2 doses, then 200 mg PO q12h200 mg PO q12h x 2 doses, then 100 mg PO q12h

3-4 mg/kg PO q12h

Child-Pugh Class A-B (score 5-9)Usual loading dose, then 50% maintenance dose

Child-Pugh Class C (score 10-15)Should only be used if benefit outweighs risk

CrCl < 50 mL/minUse PO Contraindicated due to accumulation of IV vehicle cyclodextrin

No renal adjustment necessary

Use PO Contraindicated due to accumulation of IV vehicle cyclodextrin

General Information

Primary indication(s): Invasive Aspergillus infections (including CNS aspergillosis)

Alternative indication(s): Serious Candida infections, prophylaxis in high risk hematologic patients (e.g. prolonged neutropenia at high risk of for invasive aspergillosis, GVHD)

For urinary tract infections with fungal microorganisms

Therapeutic drug monitoring recommended to ensure adequate concentrations and exclude toxicity.

  • Target 1 – 5.5 μg/mL, 5-7 days after starting therapy

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 concomitant medications due to high frequency of significant interactions.

Antimicrobial class: Triazole antifungal, Second generation

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

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