Voriconazole(vor ah kon’ ah zole)
Vfend
PREGNANCY CATEGORY D
Drug Class
Triazole antifungal
Therapeutic Actions
Inhibits fungal ergosterol biosynthesis leading to cell membrane rupture and cell death in susceptible fungi.
Indications
Treatment of invasive aspergillosis
Treatment of serious fungal infections caused by Scedosporium apiospermum, Pseudallescheria boydii, and Fusarium species in patients intolerant of or refractory to other therapy
Treatment of esophageal candidiasis
Treatment of candidemia in nonneutropenic patients with disseminated skin infections and abdominal, kidney, bladder wall, and wound infections
Contraindications and Cautions
Contraindicated with hypersensitivity to voriconazole, treatment with other drugs that could prolong the QTc interval, severe hepatic impairment, galactose intolerance, and in patients taking the following drugs: Ergot alkaloids, sirolimus, rifabutin, rifampin, carbamazepine, long-acting barbiturates, or other CYP3A4 substrates.
Use cautiously with known allergies to other azoles; pregnancy, lactation.
Available Forms
Tablets—50, 200 mg; powder for injection—200 mg to be reconstituted to 10 mg/mL; powder for oral suspension—40 mg/mL
Dosages
Adults
Loading dose of 6 mg/kg IV every 12 hr for two doses, then 3–4 mg/kg IV every 12 hr or 200 mg PO every 12 hr. Switch to oral dose as soon as patient is able:
Weight less than 40 kg: 100 mg PO every 12 hr; may increase to 150 mg PO every 12 hr if needed.
Weight of 40 kg or more: 200 mg PO every 12 hr; may increase to 300 mg PO every 12 hr if needed.
Esophageal candidiasis: 200–300 mg PO every 12 hr (reduce to 100–150 mg PO every 12 hr if weight is less than 40 kg) for 14 days or for at least 7 days following symptom resolution.
Pediatric patients younger than 12 yr
Safety and efficacy not established.
Pharmacokinetics
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Metabolism: Hepatic; T1/2: 24 hr
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