Voriconazole
Antifungal, Systemic · Triazole antifungal
Indications
Treatment of invasive aspergillosis, candidaemia, non-neutropenic patients, fluconazole-resistant serious invasive candida infections (including C krusei), serious fungal infection caused by Scedosporium species and Fusarium species. In patient with progressive possibly life threatening infections.
Dosage
INFUSION: Adults: Loading dose: For first 24 hr, 6 mg/kg by IV infusion every 12 hr. Maintenance dose: 4 mg/kg by IV infusion twice daily. If not tolerated it may be reduced to 3 mg/kg twice daily. Max infusion rate: 3 mg/kg/hr over 1-3 hr. Max treatment duration, 6 mth. Children: Under 2 yr: Not recommended; 2-12 yr: or 12-14 yr and less than 50 kg, Loading dose: For first hrs, 9 mg/kg by IV inf every 12 hrs. Maint; 8 mg/kg by IV inf twice daily. 12-14 yr and =50 kg, as adults. If response inadequate, maintenance dose may be increased in 1 mg/kg steps. If not tolerated, it may be reduced in 1 mg/kg steps. Max inf. Rate 3 mg/kg/hr over 1-3 hr. ORAL: Adults: For first 24 hr: 400 mg every 12 hr (>40 kg) or 200 mg every 12 hr (<40 kg), Maint: 200 mg twice daily (> than 40 kg) or 100 mg twice daily (<40 kg). If response inadequate it may be increased to 300 mg twice daily (> 40 kg) or 150…
Administration
Reconstitute with 19 mL of SWFI and shake well to yield 20 mL of voriconazole 10 mg/mL solution. Administered by IV infusion in a compatible infusion solution at a concentration between 0.5 and 5 mg/mL over 1 to 2 hours at a max rate of 3 mg/kg/hour. Compatibility: Dextrose 5%, NaCl 0.9%. Stability: Reconstituted soln stable for 24 hours under refrigeration, use immediately after reconstitution because no antimicrobial preservative is present. Single use only and any remaining drug should be discarded.
Adverse Effects
Headache, paresthesia, somnolence, GI upset, rash, visual disturbances, pyrexia, gastroenteritis, sinusitis, depression, hallucination, anxiety, tremors, agitation, chills, asthaenia, back and chest pain, inj or inf site reactions, acute respiratory distress syndrome, flu-like symptoms, hypotension, thrombophlebitis, phlebitis, raised LFTs and creatinine, jaundice, cheilitis, pruritus, alopecia, dermatitis, blood dyscrasia, purpura, erythema, hypokalaemia, hypoglycaemia, dizziness, confusion, acute renal failure, hematuria, peripheral pulmonary and facial oedema.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Precautions: Hepatic impairment or cirrhosis. Monitor LFTs, bilirubin; discontinue if liver disease develops. Monitor renal function. Acute pancreatitis; Monitor serum Amylase or lipase. Electrolyte imbalance; Monitor and correct prior to and during therapy. QT prolongation, cardiomyopathy, sinus bradycardia, arrhythmia, avoid direct sunlight; pregnancy, use effective contraception. Inf: moderate to severe renal impairment (CrCl< 50 mL/min).
Interactions
Rifabutin, rifampicin, phenytoin, carbamazepine, Phenobarbital, cimetidine, cisapride, pimozide, ergot alkaloids, fluconazole, sulphonylureas, coumarins, statins, benzodiazepines, vinca alkaloids, sirolimus, everolimus, other immunosuppressants, NSAIDs, opiates other substrates, indicators or inducers of CYP3A4, CYP2C19 and CYP2C9 drugs that prolong QT interval, St. John's Wort.
Advice to Patient
Take atleast 1 hour before or after meals. Contact prescriber if there is chest pain, palpitations, fast heartbeats, skin rash, chills, fever, constant GI pain, hallucinations, yellowing of eyes or skin, urinary pattern changes, colour change of urine or stool. Use effective contraception method during therapy and inform prescriber if you become pregnant. Complete full course of therapy even if you feel better. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Vision changes are reversible on discontinuation of treatment. Avoid direct sunlight, wear sunscreen, proper eyewear and protective clothing to prevent photosensitivity.
Pharmacokinetics
Metabolism: Hepatic. Bioavailability: Oral: Children 2-<12 yrs: Approx. 45%-64%. Adults: 96%. Half-life elimination: Variable, dose-dependent. Time to peak: Oral: Children 2-<12 yrs: Median: 1.1 hrs. Adults: 1-2 hrs. Excretion: Urine.
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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