voriconazole

Generic Name: voriconazole (vor i KON a zole)
Brand Names: VFEND

What is voriconazole?

Voriconazole is an antifungal medication.

Voriconazole is used to treat infections caused by yeast or other types of fungus.

Voriconazole may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about voriconazole?

Do not use voriconazole without your doctor's consent if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

There are many other medicines that can cause serious or life-threatening drug interactions with voriconazole. Tell your doctor about all the prescription and over-the-counter medications you use.

Before taking voriconazole, tell your doctor if you have heart rhythm problems, an electrolyte imbalance, liver or kidney disease, or a history of allergy to other antifungal medications such as fluconazole (Diflucan), ketoconazole (Nizoral), or itraconazole (Sporanox).

Use voriconazole for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.

Voriconazole can cause problems with your vision. If you use this medicine for more than 28 days, you may need to have your eyes checked.

What should I discuss with my healthcare provider before taking voriconazole?

Do not take this medication if you are allergic to voriconazole, or if you are taking any of the following drugs:

• quinidine (Cardioquin, Quinora, Quinidex, Quinaglute, Quin-Release, Quin-G);

• sirolimus (Rapamune);

• carbamazepine (Tegretol);

• pimozide (Orap);

• phenobarbital;

• ritonavir (Norvir);

• efavirenz (Sustiva);

• rifabutin (Mycobutin) or rifampin (Rifadin, Rimactane, Rifater);

• an ergot medicine such as ergotamine (Ergomar, Cafergot, Ercaf, Wigraine, others) or dihydroergotamine (D.H.E., Migranal); or

• (these drugs are no longer available in the U.S.) terfenadine (Seldane) or astemizole (Hismanal).

The drugs listed above can cause dangerous serious or life-threatening drug interactions with voriconazole. Tell your doctor about all other medicines you are using.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use voriconazole:

• heart rhythm problems;

• a metabolic disorder such as high or low levels of calcium, potassium, or magnesium;

• liver disease;
• kidney disease; or

• a history of allergy to other antifungal medications such as fluconazole (Diflucan), ketoconazole (Nizoral), or itraconazole (Sporanox).

Voriconazole tablets contain lactose. Before taking a voriconazole tablet, tell your doctor if you have a hereditary form of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use voriconazole without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using voriconazole. It is not known if voriconazole passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take voriconazole?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take voriconazole at least one hour before or after eating a meal. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Do not mix the oral suspension with any other medicine or liquid. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.

To be sure voriconazole is helping your condition, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

Voriconazole can cause problems with your vision. If you use this medicine for more than 28 days, you may need to have your eyes checked.

Store voriconazole tablets at room temperature away from moisture and heat. Store the oral liquid at room temperature for up to 14 days. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include vision problems, excessive mouth watering, enlarged pupils, weakness, loss of balance, shortness of breath, or seizure (convulsions).

What should I avoid while taking voriconazole?

Voriconazole may cause changes in vision including blurred vision and sensitivity to light. Wear sunglasses during the day to protect your eyes from bright light. Be careful if you drive or do anything that requires you to have clear vision. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Voriconazole can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Voriconazole side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• sudden behavior changes, problems with thinking or speech;

• stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes);

• urinating less than usual or not at all;

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or

• uneven heart rate, chest pain, general ill feeling.

Less serious side effects may include:

• vision problems such as blurred vision, eyes being more sensitive to light;

• fever;

• mild nausea, vomiting, or diarrhea;

• headache; or

• swelling in your hands, ankles, or feet.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Voriconazole Dosing Information

Usual Adult Dose for Aspergillosis -- Invasive:

Loading: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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 Blastomycosis:

Cerebral blastomycosis - Case report (n =1)
200 mg orally twice daily, then dose was increased to 300 mg orally twice daily 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:

Case report (n=1) - Coccidioides posadasii: 400 mg orally twice daily for 2.5 years. Thereafter, 200 mg orally twice daily, and lifelong therapy is planned.

Usual Adult Dose for Eumycetoma:

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

Usual Adult Dose for Esophageal Candidiasis:

Less than 40 kg: 100 mg orally twice daily for a minimum of 14 days and for at least 7 days following resolution of symptoms.

Greater than or equal to 40 kg: 200 mg orally twice daily for a minimum of 14 days and for at least 7 days following resolution of symptoms.

Usual Pediatric Dose for Aspergillosis -- Invasive:

Greater than or equal to 12 to 18 years:

Loading: 6 mg/kg IV every 12 hours for 2 doses.
Maintenance: 4 mg/kg IV every 12 hours. If dose not tolerated, may decrease to 3 mg/kg IV every 12 hours.

Once the patient can tolerate medication given by mouth, the oral tablet form of voriconazole may be utilized. Patients who weigh more than 40 kg should receive an oral maintenance dose of 200 mg every 12 hours. Patients who weigh less than 40 kg should receive an oral maintenance dose of 100 mg every 12 hours.

Usual Pediatric Dose for Ocular Fungal Infection:

Case (n=1) - Fusariosis
Greater than 16 years: 6 mg/kg orally twice daily for eight 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.

What other drugs will affect voriconazole?

Many drugs can interact with voriconazole. Below is just a partial list. Tell your doctor if you are using:

• phenytoin (Dilantin);

• cyclosporine (Sandimmune, Neoral);

• tacrolimus (Prograf);

• warfarin (Coumadin);

• stomach acid reducers such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), or pantoprazole (Protonix);

• tranquilizers or sedatives such as alprazolam (Xanax), diazepam (Valium), midazolam (Versed), triazolam (Halcion), and others;

• cholesterol-lowering medicines such as atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), or simvastatin (Zocor);

• vinblastine (Velban), vincristine (Oncovin), or vinorelbine (Navelbine);

• a calcium channel blocker such as verapamil (Isoptin, Verelan, Calan, Covera), amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop), or nisoldipine (Sular); or

• an oral diabetes medicine such as glipizide (Glucotrol), glyburide (DiaBeta, Micronase), tolbutamide (Orinase), tolazamide (Tolinase), or chlorpropamide (Diabinese).

This list is not complete and there may be other drugs that can interact with voriconazole. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about voriconazole.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 5.08. Revision Date: 06/26/2009 9:40:22 AM.

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