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Voriconazole Dosage

Medically reviewed on September 6, 2018.

Applies to the following strengths: 40 mg/mL; 50 mg; 200 mg

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 the start of therapy and at least weekly for the first month; may reduce to monthly if no significant changes)
-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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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