Voriconazole Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Aspergillosis - Invasive

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Candidemia

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Fungal Pneumonia

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Pseudoallescheriosis

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Ocular Fungal Infection

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Systemic Fungal Infection

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Cutaneous Fungal Infection

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Fungal Infection - Disseminated

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Fungal Meningitis

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Fusariosis

Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Treatment must be started with the IV loading dose on Day 1 followed by the maintenance dose. IV therapy should continue for at least 7 days. Once the patient has clinically improved and can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 90 days) and of oral therapy was 76 days (range 2 to 232 days).

Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Adult Dose for Esophageal Candidiasis

Less than 40 kg: 100 mg orally twice daily
40 kg or more: 200 mg orally twice daily

Patients should be treated for a minimum of 14 days and for at least 7 days following resolution of symptoms.

Usual Adult Dose for Blastomycosis

(Not approved by FDA)

Case report (n=1) - Cerebral blastomycosis
200 mg orally twice a day, then dose was increased to 300 mg orally twice a day after 4 weeks in an attempt to achieve a higher CNS concentration

Therapy was continued for a 12-month course.

Usual Adult Dose for Coccidioidomycosis - Meningitis

(Not approved by FDA)

Case report (n=1) - Coccidioides posadasii
400 mg orally twice a day for 2.5 years; thereafter, 200 mg orally twice a day and lifelong therapy is planned

Usual Adult Dose for Eumycetoma

(Not approved by FDA)

Case report (n=1)
200 mg orally twice a day for 3 months, followed by 300 mg orally twice a day for 13 months

Usual Pediatric Dose for Aspergillosis - Invasive

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Candidemia

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Fungal Pneumonia

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Pseudoallescheriosis

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Ocular Fungal Infection

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Systemic Fungal Infection

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Cutaneous Fungal Infection

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Fungal Infection - Disseminated

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Fungal Meningitis

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Fusariosis

2 to 11 years:
IDSA guidelines for invasive aspergillosis: 5 to 7 mg/kg IV every 12 hours

12 years or older:
Loading dose: 6 mg/kg IV every 12 hours for 2 doses

Maintenance dose:
IV:
Invasive aspergillosis and serious fungal infections due to Fusarium species and Scedosporium apiospermum: 4 mg/kg IV every 12 hours

Once the patient can tolerate medication given by mouth, the oral tablet form or oral suspension form of voriconazole may be utilized.

Candidemia in nonneutropenic patients and other deep tissue Candida infections: 3 to 4 mg/kg IV every 12 hours

During clinical trials, patients with candidemia received 3 mg/kg IV every 12 hours as primary therapy, while patients with other deep tissue Candida infections received 4 mg/kg as salvage therapy. Appropriate dose should be based on the nature and severity of the infection.

Oral:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

Duration:
Candidemia in nonneutropenic patients and other deep tissue Candida infections: Patients should be treated for at least 14 days following resolution of symptoms or following last positive culture, whichever is longer.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice a day for 8 weeks
Following keratoplasty and the surgical removal of the fungal material, the anterior chamber was irrigated with a 3 mcg/mL solution of voriconazole. Also, voriconazole 10 mcg/0.1 mL was injected intracamerally. Topical voriconazole 1% was applied every half-hour.

Usual Pediatric Dose for Esophageal Candidiasis

12 years or older:
Less than 40 kg: 100 mg orally twice daily
40 kg or more: 200 mg orally twice daily

Patients should be treated for a minimum of 14 days and for at least 7 days following resolution of symptoms.

Renal Dose Adjustments

IV:
Moderate or severe renal dysfunction (CrCl less than 50 mL/min): Accumulation of the IV vehicle (SBECD - sulfobutyl ether beta-cyclodextrin sodium, a drug solubilizing agent) occurs. Oral voriconazole should be used unless the benefit to risk ratio justifies IV use.

Oral:
Mild to severe renal dysfunction: No adjustment recommended.

Liver Dose Adjustments

The manufacturer states that no dosage adjustment is needed in patients with baseline liver function tests (ALT, AST) up to 5 times the upper limit of normal, but continued monitoring of liver function tests for further elevations is recommended.

Mild to moderate hepatic cirrhosis (Child-Pugh Class A and B):
Loading dose: No adjustment recommended.
Maintenance dose: Dose should be reduced by one-half.

Severe hepatic cirrhosis (Child-Pugh Class C), chronic hepatitis B or C disease: Data not available
Voriconazole should only be used in patients with severe hepatic insufficiency if the benefit outweighs the potential risk.

Dose Adjustments

If response is inadequate:
Less than 40 kg: The oral maintenance dose may be increased from 100 mg to 150 mg, orally every 12 hours.
40 kg or more: The oral maintenance dose may be increased from 200 mg to 300 mg, orally every 12 hours.

If unable to tolerate treatment:
If unable to tolerate 4 mg/kg IV: The IV maintenance dose should be reduced to 3 mg/kg IV every 12 hours.

If unable to tolerate 300 mg orally every 12 hours:
Less than 40 kg: The oral maintenance dose should be reduced by 50 mg steps to a minimum of 100 mg orally every 12 hours.
40 kg or more: The oral maintenance dose should be reduced by 50 mg steps to a minimum of 200 mg orally every 12 hours.

If coadministered with phenytoin:
IV: The voriconazole maintenance dose should be increased to 5 mg/kg IV every 12 hours.

Oral:
Less than 40 kg: The voriconazole maintenance dose should be increased from 100 mg to 200 mg, orally every 12 hours.
40 kg or more: The voriconazole maintenance dose should be increased from 200 mg to 400 mg, orally every 12 hours.

If coadministered with efavirenz: The voriconazole maintenance dose should be increased to 400 mg orally every 12 hours.

Precautions

Coadministration of the CYP450 3A4 substrates, astemizole, cisapride, terfenadine, pimozide, or quinidine with voriconazole are contraindicated since increased plasma concentrations of these drugs can lead to QT prolongation and rare occurrences of torsade de pointes. Coadministration of sirolimus with voriconazole is contraindicated because voriconazole significantly increases sirolimus concentrations in healthy subjects. Coadministration of rifampin, carbamazepine, and long-acting barbiturates with voriconazole is contraindicated since these drugs are likely to decrease plasma voriconazole concentrations significantly. Coadministration of high-dose ritonavir (400 mg every 12 hours) with voriconazole is contraindicated because ritonavir (400 mg every 12 hours) significantly decreases plasma voriconazole concentrations in healthy subjects. Coadministration of low-dose ritonavir (100 mg every 12 hours) with voriconazole should be avoided, unless an assessment of the benefit/risk to the patient justifies the use of voriconazole. Coadministration of rifabutin with voriconazole is contraindicated since voriconazole significantly increases rifabutin plasma concentrations and rifabutin also significantly decreases voriconazole plasma concentrations. Coadministration of ergot alkaloids (ergotamine and dihydroergotamine) with voriconazole is contraindicated because voriconazole may increase the plasma concentration of ergot alkaloids, which may lead to ergotism. Coadministration of voriconazole with St. John's Wort is contraindicated.

The effect of voriconazole on visual function is not known beyond 28 days of treatment. If therapy continues beyond 28 days, visual function including visual acuity, visual field, and color perception should be monitored.

Cases of serious hepatic reactions during treatment with voriconazole (including clinical hepatitis, cholestasis, and fulminant hepatic failure, including fatalities) have been reported in clinical trials uncommonly. Hepatic reactions occurred primarily in patients with serious underlying medical conditions (predominantly hematologic malignancy). Hepatic reactions, including hepatitis and jaundice, have been reported in patients with no other identifiable risk factors. Liver dysfunction has usually been reversible on discontinuation of voriconazole therapy.

Liver function tests should be assessed at the start of and during the course of voriconazole therapy. Patients who develop abnormal liver function tests during voriconazole treatment should be monitored for the development of more severe hepatic injury. Laboratory evaluation of hepatic function (particularly liver function tests and bilirubin) should be included in patient management. Discontinuation of voriconazole must be considered if clinical signs and symptoms consistent with liver disease develop that may be attributable to voriconazole therapy.

Voriconazole has been associated with elevated liver function tests and clinical signs of liver damage (such as jaundice) and should only be used in patients with severe liver dysfunction if benefit outweighs risk. Patients with liver dysfunction must be carefully monitored for drug toxicity.

Prolongation of the QT interval on the electrocardiogram has been reported with some azoles, including voriconazole. Rare cases of arrhythmias, (including ventricular arrhythmias such as torsade de pointes), cardiac arrests, and sudden deaths have been reported during clinical development and postmarketing surveillance in patients taking voriconazole. These reports usually involved seriously ill patients with multiple confounding risk factors, such as history of cardiotoxic chemotherapy, cardiomyopathy, hypokalemia, and concomitant medications that may have been contributory. Voriconazole should be given with caution to patients with these potentially proarrhythmic conditions.

Nonconcentration-dependent voriconazole-associated asymptomatic bradycardia, QT interval prolongation, and nonsustained, polymorphic ventricular tachycardia developed in a 15-year-old girl. Rechallenge with voriconazole confirmed a causal relationship. Pediatricians consulting on this case recommend the use of cardiac rhythm monitoring during voriconazole treatment.

Any electrolyte disturbance (such as hypokalemia, hypomagnesemia, and hypocalcemia) should be corrected prior to initiation of voriconazole therapy.

During infusion of the IV formulation of voriconazole in healthy subjects, anaphylactoid-type reactions (including flushing, fever, sweating, tachycardia, chest tightness, dyspnea, faintness, nausea, pruritus, and rash) have been reported uncommonly. Symptoms appeared immediately upon starting the infusion. If such reactions occur, stopping the infusion should be considered.

Patients have rarely developed serious exfoliative cutaneous reactions, such as Stevens-Johnson syndrome, during treatment with voriconazole. If a patient develops an exfoliative cutaneous reaction, voriconazole should be discontinued.

Voriconazole has been associated with photosensitivity skin reaction. During voriconazole therapy, it is recommended that patients avoid intense or prolonged exposure to direct sunlight. Melanoma and squamous cell carcinoma of the skin have been reported during long-term therapy in patients with photosensitivity skin reactions. If a patient develops a skin lesion consistent with melanoma or squamous cell carcinoma, voriconazole should be discontinued.

Voriconazole should be discontinued if a patient develops skeletal pain and radiologic results consistent with fluorosis or periostitis.

In patients with CrCl less than 50 mL/min, accumulation of the IV vehicle, SBECD (sulfobutyl ether beta-cyclodextrin sodium), occurs. Oral voriconazole should be administered to these patients, unless an assessment of the benefit/risk to the patient justifies the use of IV voriconazole. Serum creatinine levels should be monitored closely in these patients, and if increases occur, consideration should be given to changing to oral voriconazole therapy.

Patients should be monitored for abnormal renal function development. This should include laboratory evaluation, especially serum creatinine.

Patients with risk factors for acute pancreatitis (e.g., recent chemotherapy, hematopoietic stem cell transplantation [HSCT]) should be monitored for the development of pancreatitis during voriconazole therapy.

Voriconazole tablets contain lactose and should not be administered to patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption.

Voriconazole oral suspension contains sucrose and is not recommended for patients with rare hereditary problems of fructose intolerance, sucrase-isomaltase deficiency, or glucose-galactose malabsorption.

Safety and effectiveness have not been established in pediatric patients less than 12 years of age.

Dialysis

Voriconazole is hemodialyzed with clearance of 121 mL/min and the IV vehicle, SBECD, is hemodialyzed with clearance of 55 mL/min. A 4-hour hemodialysis session does not remove sufficient voriconazole to warrant dosage adjustment.

Other Comments

The oral maintenance dose of 200 mg provides a voriconazole exposure similar to 3 mg/kg IV; a 300 mg oral dose provides an exposure similar to 4 mg/kg IV.

Duration of therapy should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.

Voriconazole tablets or oral suspension should be taken at least one hour before, or one hour after, a meal.

The final concentration of the IV fluid must be in the range of 0.5 mg/mL to 5 mg/mL. The final voriconazole solution must be infused over 1 to 2 hours at a maximum rate of 3 mg/kg/hour.

Hide
(web1)