Voriconazole

Administration

Adult Dosing

  • 200-400mg PO BID or 4-6mg IV BID

Pediatric Dosing

  • Children >12 yo: same as adult dosing

Special Populations

  • Pregnancy Rating: D
  • Lactation risk: Infant risk cannot be ruled out
  • Renal dosing: PO preferred, no adjustement to dose
  • Hepatic dosing: mild-moderate impairment- reduce dose. Severe: avoid using

Contraindications

  • Allergy to class/drug
  • Concomitant use of carbamazepine or CYP3A4 substrates, ritonavir, ergots, barbiturates, rifampin, sirolimus, or St. John's Wort

Adverse Reactions

Serious

  • Prolonged QT, dysrhythmias, cardiac arrest
  • Erythema multiforme, SJS, TEN
  • Malignant melanoma, squamous cell carcinoma
  • Hepatotoxicity
  • Renal failure
  • Toxic encephalopathy
  • Pancreatitis
  • Optic neuritis

Common

  • Peripheral edema
  • Rash
  • Nausea/vomiting, diarrhea
  • Headache
  • Visual disturbances
  • Hallucinations
  • Fever

Pharmacology

  • Half-life: Dose dependant, non-linear pharmacokinetics
  • Metabolism: CYP2C19, CYP2C9 and CYP3A4
  • Excretion: Renal

Mechanism of Action

  • Triazole antifungal: inhibits synthesis of fungal cell wall ergosterol

Comments

See Also

References