voriconazole (Rx)

Brand and Other Names:Vfend
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension

  • 200mg/5mL

injection, powder for reconstitution

  • 200mg

tablets

  • 50mg
  • 200mg

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

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

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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

            Skin and appendages: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS)

            Skin toxicity with concomitant use of methotrexate

            Endocrine disorders: Adrenal insufficiency, Cushing’s syndrome (when voriconazole has been used concomitantly with corticosteroids)

            Pediatric

            • Blood and lymphatic system disorders: Anemia, leukopenia, pancytopenia
            • Cardiac disorders: Bradycardia, palpitations, supraventricular tachycardia
            • Eye disorders: Dry eye, keratitis
            • Ear and labyrinth disorders: Tinnitus, vertigo
            • Gastrointestinal disorders: Abdominal tenderness, dyspepsia
            • General disorders and Administration Site Conditions: asthenia, catheter site pain, chills, hypothermia, lethargy
            • Hepatobiliary disorders: Cholestasis, hyperbilirubinemia, jaundice
            • Immune system disorders: Hypersensitivity, urticaria Infections and Infestations: conjunctivitis
            • Laboratory investigations, metabolism, and nutrition disorders: Hypercalcemia, hypermagnesemia, hyperphosphatemia, hypoglycemia , AST increased, blood creatinine increased, gamma-glutamyl transferase increased
            • Metabolism and nutrition disorders: Hypercalcemia, hypermagnesemia, hyperphosphatemia, hypoglycemia
            • Musculoskeletal and connective tissue disorders: Arthralgia, myalgia
            • Nervous system disorders: Ataxia, convulsion, dizziness, nystagmus, paresthesia, syncope
            • Psychiatric disorders: Affect lability, agitation, anxiety, depression, insomnia
            • Respiratory disorders: Bronchospasm, nasal congestion, respiratory failure, tachypnea
            • Skin and subcutaneous tissue, and vascular disorders: Alopecia, dermatitis (allergic, contact, and exfoliative), pruritus, flushing, phlebitis
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            Warnings

            Contraindications

            Hypersensitivity

            Patients with galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption

            Coadministration with cisapride, astemizole, cisapride, lurasidone, pimozide, quinidine, ivabradine, efavirenz (doses ≥400 mg/day), ritonavir (high dose – 400 mg q12hr), ergot alkaloids (ergotamine, dihydroergotamine), rifabutin, sirolimus, St. John’s wort, rifampin, carbamazepine, barbiturates, naloxegol, or tolvaptan

            Coadministration with venetoclax at initiation and during ramp-up phase in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma

            Cautions

            Hypersensitivity to other azoles

            Do not give IV bolus

            Review patient’s concomitant medications

            Caution with renal impairment; patients should be monitored for development of abnormal renal function; this should include laboratory evaluation of serum creatinine

            Serious hepatic reactions reported; evaluate liver function tests at start of and during therapy; hepatic function should be monitored in both adult and pediatric patients; a higher frequency of liver enzyme elevations was observed in the pediatric patients

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

            Severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS), which can be life-threatening or fatal, reported; if patient develops a severe cutaneous adverse reaction, therapy should be discontinued

            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 deficiency, 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

            Fluorosis and periostitis 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

            Photosensitivity

            • Avoid intense or prolonged exposure to direct sunlight; in patients with photosensitivity skin reactions, pseudoporphyria, cheilitis, and cutaneous lupus erythematosus reported; patients should avoid strong, direct sunlight during therapy; squamous cell carcinoma of the skin and melanoma reported during long-term therapy; pseudoporphyria, cheilitis, and cutaneous lupus erythematosus. patients should avoid strong, direct sunlight during therapy
            • If phototoxic reactions occur, the patient should be referred to a dermatologist and therapy discontinuation considered; if therapy is continued despite occurrence of phototoxicity-related lesions, dermatologic evaluation should be performed on a systematic and regular basis to allow early detection and management of premalignant lesions
            • Squamous cell carcinoma of the skin (including cutaneous SCC in situ, or Bowen’s disease) and melanoma have been reported during long-term therapy in patients with photosensitivity skin reactions; if a patient develops a skin lesion consistent with premalignant skin lesions, squamous cell carcinoma or melanoma, therapy should be discontinued
            • Therapy has also been associated with photosensitivity related skin reactions such as pseudoporphyria, cheilitis, and cutaneous lupus erythematosus
            • Frequency of phototoxicity reactions is higher in the pediatric population; because squamous cell carcinoma has been reported in patients who experience photosensitivity reactions, stringent measures for photoprotection are warranted in children
            • In children experiencing photoaging injuries such as lentigines or ephelides, sun avoidance and dermatologic follow-up are recommended even after treatment discontinuation
            • Increased risk of skin toxicity with concomitant use of methotrexate, a drug associated with ultraviolet (UV) reactivation reported; there is potential for this risk to be observed with other drugs associated with UV reactivation; patients should avoid strong, direct sunlight during therapy

            Renal toxicity

            • Hydroxypropyl-β-cyclodextrin (HPβCD), the intravenous vehicle of Voriconazole for injection, is eliminated through glomerular filtration; therefore, accumulation of HPβCD occurs in patients with moderate to severe renal dysfunction (creatinine clearance <50 mL/min), accumulation of HPβCD occurs. Serum creatinine (Scr) levels should be closely monitored in patients with renal impairment. If increases in Scr occur, consideration should be given to changing to alternate antifungal therapy with similar coverage, unless an assessment of the benefit/risk to the patient justifies the continued use of intravenous voriconazole ><50 mL/min)
            • Serum creatinine (Scr) levels should be closely monitored in patients with renal impairment; if increases in Scr occur, consideration should be given to changing to alternate
            • antifungal therapy with similar coverage, unless an assessment of benefit/risk to patient justifies continued use of intravenous voriconazole
            • Acute renal failure has been observed in patients undergoing treatment with Voriconazole for injection; patients being treated with voriconazole are likely to be treated concomitantly with nephrotoxic medications and may have concurrent conditions that may result in decreased renal function
            • Patients should be monitored for development of abnormal renal function; this should include laboratory evaluation of serum creatinine

            Adrenal insufficiency

            • Adrenal insufficiency reported in patients receiving azoles with or without concomitant corticosteroids
            • In patients receiving azoles without corticosteroids adrenal insufficiency is related to direct inhibition of steroidogenesis by azoles; in patients taking corticosteroids, voriconazole associated CYP3A4 inhibition of their metabolism may lead to corticosteroid excess and adrenal suppression
            • Cushing’s syndrome with and without subsequent adrenal insufficiency reported in patients receiving therapy concomitantly with corticosteroids; patients receiving drug and corticosteroids (via all routes of administration) should be carefully monitored for adrenal dysfunction both during and after treatment
            • Patients should be instructed to seek immediate medical care if they develop signs and symptoms of Cushing’s syndrome or adrenal insufficiency

            Drug interaction overview

            • The drug is metabolized by cytochrome P450 isoenzymes, CYP2C19, CYP2C9, and CYP3A4; inhibitors or inducers of these isoenzymes may increase or decrease voriconazole plasma concentrations, respectively
            • The drug is a strong inhibitor of CYP3A4, and also inhibits CYP2C19 and CYP2C9; voriconazole may increase plasma concentrations of substances metabolized by these CYP450 isoenzymes
            • 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; coadministration of voriconazole and low-dose ritonavir (100 mg every 12 hours) should be avoided, unless an assessment of benefit/risk to the patient justifies therapy
            • 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
            • Naloxegol: Voriconazole increases naloxegol concentration levels, which may precipitate opioid withdrawal symptoms
            • Tolvaptan: Voriconazole may increase tolvaptan plasma concentrations, which may increase risk of adverse reactions
            • Coadministration with venetoclax at initiation and during the ramp-up phase contraindicated in chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) due to potential for increased risk of tumor lysis syndrome
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            Pregnancy & Lactation

            Pregnancy

            Therapy can cause fetal harm when administered to a pregnant woman; there are no available data on pregnant women

            Advise females of reproductive potential to use effective contraception during treatment

            Animal data

            • Treatment was administered orally to pregnant rats during organogenesis (gestation days 6-17) at 10, 30, and 60 mg/kg/day
            • Therapy was associated with malformations resulting in increased incidences in hydroureter and hydronephrosis at 10 mg/kg/day or greater ( approximately 0.3 times the recommended human dose (RMD) based on body surface area comparisons), and cleft palate at 60 mg/kg ( approximately 2 times the RMD based on body surface area comparisons)
            • Reduced ossification of sacral and caudal vertebrae, skull, pubic, and hyoid bone, supernumerary ribs, anomalies of the sternbrae, and dilatation of the ureter/renal pelvis were also observed at doses of 10 mg/kg or greater; there was no evidence of maternal toxicity at any dose
            • The drug was administered orally to pregnant rabbits during period of organogenesis (gestation days 7-19) at 10, 40, and 100 mg/kg/day; treatment was associated with increased post-implantation loss and decreased fetal body weight, in association with maternal toxicity (decreased body weight gain and food consumption) at 100 mg/kg/day (6 times the RMD based on body surface area comparisons)
            • Fetal skeletal variations (increases in the incidence of cervical rib and extra sternebral ossification sites) were observed at 100 mg/kg/day
            • In a peri- and postnatal toxicity study in rats, voriconazole was administered orally to female rats from implantation through end of lactation at 1, 3, and 10 mg/kg/day; the treatment prolonged the duration of gestation and labor and produced dystocia with related increases in maternal mortality and decreases in perinatal survival of F1 pups at 10 mg/kg/day, approximately 0.3 times the RMD

            Lactation

            No data are available regarding presence of drug in human milk, the effects of voriconazole on breastfed infant, or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child or from underlying maternal condition

            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.

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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

            BRAND FORM. UNIT PRICE PILL IMAGE
            voriconazole intravenous
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            200 mg vial
            voriconazole intravenous
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            200 mg vial
            voriconazole intravenous
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            200 mg vial
            Vfend IV intravenous
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            200 mg vial
            Vfend IV intravenous
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            200 mg vial
            Vfend IV intravenous
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            200 mg vial
            Vfend IV intravenous
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            200 mg vial
            Vfend oral
            -
            50 mg tablet
            Vfend oral
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            200 mg tablet
            Vfend oral
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            200 mg/5 mL (40 mg/mL) suspension
            voriconazole oral
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            50 mg tablet
            voriconazole oral
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            200 mg tablet
            voriconazole oral
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            200 mg tablet
            voriconazole oral
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            50 mg tablet
            voriconazole oral
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            200 mg tablet
            voriconazole oral
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            200 mg tablet
            voriconazole oral
            -
            200 mg tablet
            voriconazole oral
            -
            200 mg/5 mL (40 mg/mL) suspension
            voriconazole oral
            -
            200 mg tablet
            voriconazole oral
            -
            50 mg tablet
            voriconazole oral
            -
            50 mg tablet
            voriconazole oral
            -
            200 mg tablet
            voriconazole oral
            -
            50 mg tablet
            voriconazole oral
            -
            200 mg/5 mL (40 mg/mL) suspension
            voriconazole oral
            -
            50 mg tablet
            voriconazole oral
            -
            200 mg/5 mL (40 mg/mL) suspension
            voriconazole oral
            -
            50 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Patient Education
            voriconazole oral

            VORICONAZOLE SUSPENSION - ORAL

            (VOR-i-KON-a-zole)

            COMMON BRAND NAME(S): Vfend

            USES: Voriconazole is used to treat a variety of fungal infections. It belongs to a class of drugs known as azole antifungals. It works by stopping the growth of fungi.

            HOW TO USE: Read the Patient Information Leaflet and Instructions for Use if available from your pharmacist before you start taking voriconazole and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth without food (at least 1 hour before or 1 hour after meals) as directed by your doctor, usually every 12 hours.Shake the bottle well before each dose. Carefully measure the dose using the special measuring device provided. Do not use a household spoon because you may not get the correct dose.The dosage and length of treatment are based on your medical condition, weight, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).For the best effect, take this antifungal at evenly spaced times. To help you remember, take this medication at the same times every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition does not get better or if it gets worse.

            SIDE EFFECTS: Nausea/vomiting and headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: vision changes (such as blurred vision, color vision changes), sensitivity of eyes to light (photophobia), eye pain, signs of kidney problems (such as change in the amount of urine), bone/joint pain, mental/mood changes (such as hallucinations), swelling hands/ankles/feet, easy bruising/bleeding, unusual skin changes, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting.Voriconazole has rarely caused very serious (possibly fatal) liver disease. Tell your doctor right away if you develop symptoms of liver disease, such as: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.Voriconazole can commonly cause a mild rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe allergic reaction. Get medical help right away if you develop any rash.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever that doesn't go away, new or worsening lymph node swelling, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking voriconazole, tell your doctor or pharmacist if you are allergic to it; or to other azole antifungals (such as itraconazole); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, heart problems (such as irregular heartbeat).Voriconazole may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using voriconazole, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using voriconazole safely.This drug may cause vision changes. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely. Do not drive at night.Avoid alcoholic beverages since they can increase the risk of serious liver problems.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This product contains sucrose (sugar). Caution is advised if you have diabetes or any other condition that requires you to limit/avoid this substance in your diet. Ask your doctor or pharmacist about using this product safely.Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).Children may be at greater risk for liver problems and being more sensitive to the sun while using this drug (see above).Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using voriconazole. Voriconazole may harm an unborn baby. Ask about reliable forms of birth control while using this medication. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Voriconazole can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include eletriptan, ergot alkaloids (such as dihydroergotamine, ergotamine), certain drugs to treat irregular heartbeat (such disopyramide, dronedarone, quinidine), ivabradine, lurasidone, naloxegol, pimozide, ranolazine, sirolimus, certain "statin" cholesterol drugs (such as lovastatin, simvastatin), tolvaptan, among others.Other medications can affect the removal of voriconazole from your body, which may affect how voriconazole works. Examples include butalbital, efavirenz, mitotane, rifamycins (such as rifabutin, rifampin), ritonavir, secobarbital, certain drugs used to treat seizures (such as carbamazepine, phenobarbital), St. John's wort, among others.Many drugs besides voriconazole may affect the heart rhythm (QT prolongation), including pacritinib, among others.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as liver/kidney function, blood mineral levels) should be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not refrigerate or freeze. Discard any unused portion after 14 days. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised October 2022. Copyright(c) 2022 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.