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Vfend (voriconazole) Disease Interactions

There are 4 disease interactions with Vfend (voriconazole):

Major

Voriconazole (Includes Vfend) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Hepatotoxicity, including clinical hepatitis, cholestasis and fulminant hepatic failure, has been reported infrequently in patients receiving voriconazole. Most cases have been reversible upon discontinuation of therapy, although fatalities have been reported. Hepatic reactions have primarily occurred in patients with serious underlying medical conditions, predominantly hematological malignancy. However, some occurred in patients with no other identifiable risk factor. Therapy with voriconazole should be administered cautiously in all patients but particularly those with preexisting liver disease, liver enzyme abnormalities, or hepatitis. Liver function tests should be evaluated prior to and during the course of therapy. Discontinuation of therapy should be considered if clinical signs and symptoms consistent with liver injury develop that may be attributable to voriconazole.

Voriconazole is primarily metabolized by the liver and has been shown to accumulate significantly in patients with impaired hepatic function. In eight patients with mild (Child-Pugh Class A) and four patients with moderate (Child-Pugh Class B) hepatic impairment given a single 200 mg oral dose, the mean systemic exposure (AUC) was 3.2-fold higher than in matched controls with normal hepatic function. When only the mild group was compared with controls, there was still a 2.3-fold increase in mean AUC. Pharmacokinetic-pharmacodynamic analyses of data from premarketing clinical trials have identified positive associations between plasma voriconazole concentrations and frequency rate of both liver function test abnormalities and visual disturbances, thus dosage adjustments are necessary to avoid undue toxicity. The manufacturer recommends that the standard loading dose regimens be used but that maintenance dose be halved in patients with mild to moderate hepatic cirrhosis. No pharmacokinetic data or dosing recommendations are available for patients with severe hepatic cirrhosis. Voriconazole should only be used in such patients if benefit outweighs the potential risk. No dosage adjustment is necessary for patients with baseline liver function tests up to 5 times the upper limit of normal. However, continued monitoring of liver function tests for further elevations is recommended.

References

  1. "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals, New York, NY.
Moderate

Azole Antifungals (Includes Vfend) ↔ Qt Prolongation

Moderate Potential Hazard, Moderate plausibility

Applies to: Long QT Syndrome, Arrhythmias

Most of the azole antifungals have been associated with prolongation of the QT interval. There have been postmarketing rare reports of QT prolongation, and torsade de pointes usually involving patients with risk factors such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

Moderate

Voriconazole (Includes Vfend) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

The pharmacokinetics of voriconazole are not significantly altered in patients with impaired renal function. However, accumulation of the intravenous vehicle, sulfobutyl ether beta-cyclodextrin sodium (SBECD), has been demonstrated in patients with moderate renal dysfunction. The mean systemic exposure (AUC) and peak plasma concentrations (Cmax) of SBECD were increased by 4-fold and almost 50%, respectively, compared to controls with normal renal function. The manufacturer recommends that the intravenous formulation of voriconazole not be used in patients with moderate to severe renal impairment (CrCl < 50 mL/min), unless benefit outweighs the potential risk. No dosage adjustment is necessary when using the oral formulation of voriconazole. However, continued monitoring of renal function for further deterioration is recommended.

References

  1. "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals, New York, NY.
Moderate

Voriconazole (Includes Vfend) ↔ Risk Of Pancreatitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Bone Marrow Transplantation

Patients with risk factors for acute pancreatitis such as recent chemotherapy or stem cell transplantation, should be monitored for the development of pancreatitis during treatment with voriconazole tablets.

Vfend (voriconazole) drug Interactions

There are 720 drug interactions with Vfend (voriconazole)

Vfend (voriconazole) alcohol/food Interactions

There is 1 alcohol/food interaction with Vfend (voriconazole)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. 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.

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