Voriconazole Dosage

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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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

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

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-Infectious Diseases Society of America (IDSA) guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

IDSA guidelines for empirical and preemptive therapy:
-IV: 6 mg/kg IV every 12 hours for 2 doses, then 3 mg/kg IV every 12 hours
-Oral: 200 mg orally every 12 hours

Usual Adult Dose for Esophageal Candidiasis

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

Duration of therapy: At least 14 days and at least 7 days after symptoms resolve

Usual Adult Dose for Blastomycosis

IDSA guidelines for CNS disease: 200 to 400 mg orally twice a day
Duration of therapy: At least 12 months and until CSF abnormalities resolve

Comments:
-An oral azole is recommended for step-down therapy after an initial regimen of liposomal amphotericin B.
-Not approved by US FDA.

Case report (n=1)
Cerebral blastomycosis: 200 mg orally twice a day

Comments:
-Dose was increased to 300 mg orally twice a day after 4 weeks in an attempt to achieve a higher CNS level.
-Therapy continued for 12 months.

Usual Pediatric Dose for Aspergillosis - Invasive

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Candidemia

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Fungal Pneumonia

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Pseudoallescheriosis

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Systemic Fungal Infection

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Cutaneous Fungal Infection

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Fungal Infection - Disseminated

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Fungal Meningitis

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Fusariosis

2 to 11 years:
American Academy of Pediatrics recommendations: 9 mg/kg IV or orally every 12 hours
Maximum dose: 350 mg/dose

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 S apiospermum: 4 mg/kg IV every 12 hours

Comments:
-Therapy should start 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 oral medication, oral voriconazole may be used.

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

Comments:
-In clinical trials, candidemia was treated using 3 mg/kg IV every 12 hours as primary therapy, while other deep tissue Candida infections were treated using 4 mg/kg IV every 12 hours 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 of Therapy:
-Invasive aspergillosis: In a clinical trial, the median duration of IV therapy was 10 days (range 2 to 85 days) and of oral therapy was 76 days (range 2 to 232 days).
-IDSA guidelines for invasive aspergillosis: At least 6 to 12 weeks; in immunosuppressed patients, throughout immunosuppression and until lesions resolve
-Candidemia in nonneutropenic patients and other deep tissue Candida infections: At least 14 days after symptoms resolve or after last positive culture, whichever is longer

Uses: Invasive aspergillosis; candidemia in nonneutropenic patients; disseminated Candida infections in skin; Candida infections in abdomen, kidney, bladder wall, wounds; serious fungal infections due to Fusarium species and S apiospermum in patients intolerant of (or refractory to) other therapy

Usual Pediatric Dose for Esophageal Candidiasis

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

Duration of therapy: At least 14 days and at least 7 days after symptoms resolve

Renal Dose Adjustments

IV:
Moderate or severe renal dysfunction (CrCl less than 50 mL/min): Oral voriconazole should be used unless the benefit to risk ratio justifies IV use.

Comments:
-Accumulation of the IV vehicle, SBECD (sulfobutyl ether beta-cyclodextrin sodium), occurs.
-Close monitoring recommended; if serum creatinine levels increase, switching to oral therapy should be considered.

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

Liver Dose Adjustments

Patients with baseline liver function tests (ALT, AST) up to 5 times the upper limit of normal: No adjustment recommended.

Comments: Continued monitoring of liver function tests for further elevations is recommended.

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

Severe liver cirrhosis (Child-Pugh C), chronic HBV, or chronic HCV: Data not available

Comments: This drug should be used in patients with severe liver dysfunction only if the benefit outweighs the risk.

Dose Adjustments

If patient is unable to tolerate 4 mg/kg IV every 12 hours: Reduce IV maintenance dose to 3 mg/kg IV every 12 hours.

If patient response is inadequate:
Less than 40 kg: Increase oral maintenance dose to 150 mg orally every 12 hours.
40 kg or more: Increase oral maintenance dose to 300 mg orally every 12 hours.

If patient is unable to tolerate the higher dose, reduce oral maintenance dose by 50 mg steps to a minimum of:
Less than 40 kg: 100 mg orally every 12 hours
40 kg or more: 200 mg orally every 12 hours

The maintenance dose should be increased if coadministered with phenytoin or efavirenz; the manufacturer product information should be consulted.

Precautions

Safety and efficacy have not been established in patients younger than 12 years.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis: No adjustment recommended.

Comments:
-Hemodialysis clearance of voriconazole is 121 mL/min.
-Hemodialysis clearance of SBECD is 55 mL/min.
-A 4-hour hemodialysis session does not remove enough voriconazole to require dose adjustment.

Other Comments

Administration advice:
-Infuse the final IV solution over 1 to 2 hours at a maximum rate of 3 mg/kg/hour; do not administer as IV bolus injection.
-Do not infuse concomitantly with any blood product or concentrated electrolytes, even if separate IV lines or cannulas.
-May infuse concurrently with other IV solutions containing non-concentrated electrolytes; infuse through a separate line.
-May infuse concurrently with total parenteral nutrition; infuse through a separate line or a different port (if multiple-lumen catheter).
-May switch between IV and oral formulations as clinically indicated; appropriate due to high oral bioavailability.
-Take the tablets or oral suspension at least 1 hour before or after a meal; shake the oral suspension about 10 seconds before each use.
-Duration of therapy depends on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.

Storage requirements:
-IV (unreconstituted vials), Tablets: Store at 15C to 30C (59F to 86F).
-IV (in-use): If not used at once, storage should not exceed 24 hours at 2C to 8C (36F to 46F).
-Oral suspension (before reconstitution): Store at 2C to 8C (36F to 46F).
-Oral suspension (reconstituted): Store at 15C to 30C (59F to 86F); do not refrigerate or freeze; close container tightly; discard 14 days after reconstitution.

Reconstitution/preparation techniques:
-IV: Requires reconstitution to 10 mg/mL and then dilution to 5 mg/mL or less before infusion; the manufacturer product information should be consulted.
-Oral suspension: Should not mix with any other drug or additional flavoring agent; the manufacturer product information should be consulted.

IV compatibility:
-Compatible diluents: 0.9% Sodium Chloride USP; Lactated Ringers USP; 5% Dextrose and Lactated Ringers USP; 5% Dextrose and 0.45% Sodium Chloride USP; 5% Dextrose USP; 5% Dextrose and 20 mEq Potassium Chloride USP; 0.45% Sodium Chloride USP; 5% Dextrose and 0.9% Sodium Chloride USP
-Incompatibilities: 4.2% Sodium Bicarbonate Infusion

General:
-The oral maintenance dose of 200 mg provides voriconazole exposure similar to 3 mg/kg IV; a 300 mg oral dose provides exposure similar to 4 mg/kg IV.
-Therapeutic monitoring has been suggested for serious infections.

Monitoring:
-Gastrointestinal: Pancreatic function in patients with risk factors for pancreatitis
-General: For drug toxicity in patients with liver dysfunction
-Hepatic: Hepatic function, especially liver function tests and bilirubin (at start of and during therapy); for more severe liver injury in patients with abnormal liver function tests (during therapy)
-Metabolic: Electrolyte disturbances (before starting and during therapy)
-Ocular: Visual function, including visual acuity, visual field, color perception (if therapy extends beyond 28 days)
-Renal: Renal function, especially serum creatinine

Patient advice:
-Do not drive at night while using this drug.
-Until you know how this drug affects you, avoid potentially hazardous tasks (such as driving or operating machinery).
-Avoid direct sunlight; use sunscreen and wear protective clothing if sun exposure cannot be avoided.

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