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voriconazole (Rx)Brand and Other Names:Vfend

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension

  • 200mg/5mL

injection, powder for reconstitution

  • 200mg

tablets

  • 50mg
  • 200mg
more...

Invasive Aspergillosis

In clinical trials, the majority of isolates recovered were Aspergillus fumigatus

6 mg/kg IV q12hr for first 24 hours, then 4 mg/kg IV q12hr or 200 mg PO q12hr  

Median duration of treatment: IV 10 days (range 2-90 days); PO 76 days (range 2-232 days)

Candidemia

Indicated for candidemia in non-neutropenic patients with other deep tissue Candida infections (eg, Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis, Candida tropicalis)

6 mg/kg IV q12hr for first 24 hours, then 3- 4 mg/kg IV q12hr or 200 mg PO q12hr 

Esophageal Candidiasis

Candida albicans, Candida glabrata, Candida krusei

200 mg PO q12hr

Serious Fungal Infections

Caused by Scedosporium apiospermum (asexual form of Pseudallescheria boydii) and Fusarium spp. including Fusarium solani, in patients intolerant of or refractory to other therapy

6 mg/kg IV q12hr for first 24 hours, then 4 mg/kg IV q12hr or 200 mg PO q12hr 

Dosage Modification

Adults weighing <40 mg: Decrease PO maintenance dose by 50%

Renal impairment (CrCl <50 mL/min): Use oral form only for maintenance; avoid IV administration because of accumulation of IV vehicle (SBECD)

Hepatic impairment

  • Mild-moderate (Child-Pugh A or B): Administer standard loading dose, but decrease maintenance dose by 50%
  • Severe (Child-Pugh C): No data available
  • Hepatitis B or C: No data available

Inadequate response

  • Increase PO maintenance dose from 200 mg q12hr to 300 mg q12hr
  • <40 kg: Increase PO maintenance dose from 100 mg q12hr to 150 mg q12hr

Administration

Infuse IV over 1-2 hr, not to exceed 3 mg/kg/hr

Take oral form 1 hr before or after meal

Dosage Forms & Strengths

oral suspension

  • 200mg/5mL

injection, powder for reconstitution

  • 200mg

tablets

  • 50mg
  • 200mg
more...

Invasive Aspergillosis

In clinical trials, the majority of isolates recovered were Aspergillus fumigatus

<12 years: Safety and efficacy not established

≥12 years: 6 mg/kg IV q12hr for first 24 hours, then 4 mg/kg IV q12hr or 200 mg PO q12hr

Median duration of treatment: IV 10 days (range 2-90 days); PO 76 days (range 2-232 days)

Candidemia

Indicated for candidemia in non-neutropenic patients with other deep tissue Candida infections (eg, Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis, Candida tropicalis)

<12 years: Safety and efficacy not established

≥12 years: 6 mg/kg IV q12hr for first 24 hours, then 3- 4 mg/kg IV q12hr or 200 mg PO q12hr

Esophageal Candidiasis

Candida albicans, Candida glabrata, Candida krusei

<12 years: Safety and efficacy not established

≥12 years: 200 mg PO q12hr

Serious Fungal Infections

Caused by Scedosporium apiospermum (asexual form of Pseudallescheria boydii) and Fusarium spp. including Fusarium solani, in patients intolerant of or refractory to other therapy

<12 years: Safety and efficacy not established

≥12 years: 6 mg/kg IV q12hr for first 24 hours, then 4 mg/kg IV q12hr or 200 mg PO q12hr

Susceptible Fungal Infections (Off-label, Aged 2-12 yr)

9 mg/kg/dose IV/PO q12hr; not to exceed 350 mg/dose

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Interactions

Interaction Checker

voriconazole and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
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            Adverse Effects

            >10%

            Visual changes (photophobia, color changes, increased or decreased visual acuity, or blurred vision occur in 21%)

            1-10%

            Tachycardia

            Hypertension

            Hypotension

            Vasodilation

            Peripheral edema

            Fever

            Chills

            Headache

            Hallucinations

            Dizziness

            Rash

            Pruritus

            Photosensitizing skin reactions

            Hypokalemia

            Hypomagnesemia

            Nausea

            Vomiting

            Abdominal pain

            Diarrhea

            Xerostomia

            Thrombocytopenia

            Alkaline phosphatase increased

            Serum transaminases increased, ALT/AST increased

            Cholestatic jaundice

            ARF

            Postmarketing Reports

            Visual disturbances including optic neuritis and papilledema

            Fluorosis and periostitis

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            Warnings

            Contraindications

            Hypersensitivity

            Tablet contains lactose and is contraindicated in patients with galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption

            Cisapride, astemizole, cisapride, pimozide, or quinidine: Voriconazole may increase plasma levels of these drugs and result in QT prolongation

            Efavirenz (doses ≥400 mg/day): Efavirenz decreases voriconazole levels and voriconazole increases efavirenz levels

            Ritonavir (high dose – 400 mg q12hr): Ritonavir decreases voriconazole levels

            Ergot alkaloids: Voriconazole increases levels of ergot alkaloids (ergotamine, dihydroergotamine)

            Rifabutin: Voriconazole increases rifabutin levels, and rifabutin decreases voriconazole levels

            Sirolimus: Voriconazole increases sirolimus levels

            St. John’s wort, rifampin, carbamazepine, barbiturates: Decreases voriconazole levels

            Cautions

            Hypersensitivity to other azoles

            Do not give IV bolus

            Review patient’s concomitant medications

            Caution with renal impairment

            Serious hepatic reactions reported; evaluate liver function tests at start of and during therapy

            Avoid intense or prolonged exposure to direct sunlight; in patients with photosensitivity skin reactions, squamous cell carcinoma of the skin and melanoma have been reported during long-term therapy

            No activity against Zygomycetes; some evidence suggests expanded use associated with increase incidence of zygomycosis

            Visual disturbances, including optic neuritis and papilledema, reported; monitor visual function if treatment lasts >28 days

            Not for administration to pregnant women unless benefits outweigh risks to fetus; inform patient of hazard

            Not for use in patients with hereditary galactose, intolerance, Lapp lactase deficienty, or glucose-galactose malabsorption

            Therapy associated with prolongation of the QT interval; caution in patients with proarrhythmic conditions, including congenital or acquired QT-prolongation, sinus bradycardia, existing symptomatic arrhythmias, or cardiomyopathy, especially if heart failure present; correct potassium, magnesium, and calcium before initiating therapy

            Stop infusion if infusion related reactions occur

            Discontinue for exfoliative cutaneous reactions or phototoxicity; avoid sunlight due to risk of photosensitivity

            Fluorosis and priostitis reported with long-term treatment; discontinue if they occur

            Monitor patients with risk factors for acute pancreatitis (eg, recent chemotherapy, hematopoietic stem cell transplantation) for pancreatitis symptoms during therapy

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: Not known if excreted in breast milk, a decision should be made whether to discontinue nursing or drug; weigh risk/benefit

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Triazole antifungal agent: Acts by inhibition of fungal cytochrome P-450 and sterol C-14 alpha-demethylation; decreases ergosterol synthesis and inhibits fungal cell membrane formation

            Pharmacokinetics

            Half-Life: Variable, dose-dependent due to non-linear kinetics

            Peak Plasma Time: 1-2 hr

            Vd: 4.6 L/Kg

            Protein binding: 58%

            Metabolism: Via hepatic CYP2C19, CYP2C9, CYP3A4

            Bioavailability: 96%

            Excretion: urine (80%)

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            Administration

            IV Preparation

            Reconstitute with 19 mL SWI to obtain an extractable volume of 20 mL of 10 mg/mL solution

            Shake until fully dissolved

            Reconstituted product can be further diluted for infusion in NS, LR, D5W, 1/2NS, 5% dextrose in LR, 5% dextrose in NS, 5% dextrose in 1/2NS, 5% dextrose in 20 mEq KCl

            No preservatives-best to use immediately after reconstitution

            IV Administration

            Calculate amount of Vfend required, withdraw and discard at least an equal volume from infusion bag or bottle and add Vfend solution to the bag or bottle

            Final infusion conc should be 5 mg/mL or less

            IV infusion over 1-2 hr, NMT 3 mg/kg/hr

            IV Incompatibilities

            Any other drugs, parenteral nutrition, Na bicarb

            Storage

            Store vials at 15-30°C (59-86°F)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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