Voriconazole

제한된
1
C. difficile 위험도
Low
경구생체이용률
Excellent

Dosing

Invasive aspergillosisCandidemia in non-neutropenic patientsDisseminated candidiasisScedosporiosis, fusariosis6 mg/kg IV q12h 2 doses, then 4 mg/kg IV q12h6 mg IV q12h 2 doses, then 3 mg/kg IV q12h 6 mg IV q12h 2 doses, then 4 mg/kg IV q12h6 mg/kg IV q12h 2 doses, then 4 mg/kg IV q12h

Maintenance therapy for invasive aspergillosis, candidemia in non-neutropenic patients, disseminated candidiasisEsophageal candidiasisBW <40 kg200 mg PO q12h200 mg PO q12h Oral dose should be reduced to 100-150 mg PO q12h

Safety and effectiveness in pediatric patients <12y of age have not been established

Mild or moderate hepatic impairmentSevere hepatic impairment50% maintenance doseNo data

CrCl ≥50CrCl <50No dose adjustmentAvoid

No dose adjustment

General Information

Candida infections both mucocutaneous and invasive (i.e. Candidemia).

Antifungal prophylaxis in immunocompromised patients.

Monitor renal function, especially serum creatinine.

Obtain fungal cultures and other relevant laboratory studies such as histopathology prior to therapy.

Assess visual function if used beyond 28 days.

Monitor serum transaminase levels, bilirubin, serum trough concentrations, and hepatic function.

Common

  • Diarrhea

  • Nausea

  • Vomiting

  • Hypokalemia

  • Headache

  • Fever

Serious

  • Prolonged QT interval

  • Torsades de pointes

  • Cholestasis (rare)

  • Liver failure (rare)

Contraindications:

  • Alkaloids (including ergotamine and dihydroergotamine)

  • HMG-CoA reductase inhibitors

  • CY3A4 substrates

  • Sirolimus

  • QT interval prolonging drugs

  • CYP450 interactions ++

Review of patient medications due to high frequency of significant interactions.

Antimicrobial class: Antifungal, 2nd Generation Triazole

Pregnancy category: D

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor

Precautions:

  • Avoid IV formulation in patients with moderate or severe renal impairment (ie, CrCl <50 mL/min) unless benefits justify use.

  • Use cautiously in patients with hypersensitivity to other azole antifungal agents.

  • Pediatric patients at increased risk for phototoxic reactions; monitoring recommended.

  • Monitoring recommended for liver enzyme elevations and hepatic reactions.

  • Do not administer tablets to patients with galactose intolerance.

  • If phototoxic reactions occur, refer patient to dermatologist and consider discontinuation of therapy.

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