Low
Excellent
PO: $5-10/day
IV: $60-70/day
CrCl < 50 mL/minIV Dosing
6mg/kg IV load q12h then 4 mg/kg q12h
Convert to oral when possible.
Vehicle to make voriconazole soluble can accumulate in renal dysfunction - unclear clinical significance
PO Dosing
Therapeutic drug monitoring recommended (Voriconazole trough)
IV Dosing
6mg/kg IV q12h x 2 doses then 4mg/kg IV q12h
PO Dosing
400mg PO q12h x 2 doses then 200mg PO q12h or 4 mg/kg q12h
May consider adjusted body weight in obese patients
Severe impairment (Child-Pugh C)
Should only be used if benefit outweighs risk
Mild to moderate (Child-Pugh A/B)
Standard loading dose then reduce maintenance by 50%
Antifungal prophylaxis in immunocompromised patients where mould coverage is required
Aspergillus infections
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (Discuss with ID). Send voriconazole trough level 30 min before dose is due. Nonlinear kinetics.
QTc interval in patients at elevated risk.
Always double check drug drug interactions.
Monitor hepatic profile.
Drug interactions
QTc prolongation
Hepatic enzyme abnormalities
Rash - up to 20%
Visual disturbance
Fluorosis
GI upset
Lots!!
CYP450 interactions ++.
Other QTc prolonging agents.
Recommend review of pt medications due to high frequency of significant interactions.
Antimicrobial class: Triazole antifungal, Second generation
Pregnancy category: D
CSF penetration: Therapeutic
Lung penetration: Therapeutic
Urine penetration: Poor
