Tablet: 50 mg, 200 mg
Injection: 200 mg
Fluconazole-resistant serious invasive Candida (including C krusei)
Oral dose (tablets and suspension)
>40 kg 400 mg (10ml) every 12 hours (for the first 24 hours) then 200 mg twice a day
<40kg 200 mg (5ml) every 12 hours (for the first 24 hours) then 100 mg twice a day
6 mg/kg every 12 hours (for the first 24 hours) then 4 mg/kg twice a day
Invasive pulmonary aspergillosis
6 mg/kg every 12 hours (for the first 24 hours) then 4 mg/kg twice a day for at least 7 days, followed by
>40kg 200 mg orally twice a day or if
<40kg 100mg orally twice a day
to complete a total of 12 weeks therapy
Consider oral voriconazole or itraconazole in patients with low immunity
Oral biovailability 96%
Influenza-like illness, gastroenteritis, thrombocytopenia, anaemia, leukopenia, pancytopenia, sinusitis, hypoglycaemia, hypokalaemia, anxiety, depression, hallucination, headache, dizziness, visual disturbance, oedema peripheral, respiratory distress, pulmonary oedema, chest pain, abdominal pain, nausea, vomiting, diarrhoea, cholestatic jaundice, rash, erythema face oedema, pruritis
Co-administration of the CYP3A4 substrates, terfenadine, astemizole, cisapride, pimozide or quinidine is contraindicated since increased plasma concentrations of these medicinal products can lead to QT prolongation and rare occurrences of torsades de pointes.
Co-administration of voriconazole with rifampicin, carbamazepine and phenobarbital is contraindicated since these medicinal products are likely to decrease plasma voriconazole concentrations significantly.
Phenytoin, methadone and rifabutin levels may increase with voriconazole and may result in toxicity.
Check specific SmPC for specific drug interactions with antiretrovirals.
Some examples include:
When voriconazole and efavirenz are co-prescribed the dose of voriconazole should be increased to 400 mg every 12 hours and efavirenz should be decreased to 300 mg every 24 hours
Low-dose ritonavir boosting may reduce levels of voriconazole –caution
Dose in renal impairment GFR (ml/min)
Oral dosing: No dosage reduction in renal impairment
IV infusion formulation:
<50: accumulation of the vehicle within the formulation occurs and the oral preparation should be used and serum creatinine carefully monitored in renally impaired patients
No dosage adjustment is required in patients with acute hepatic damage
Monitor LFTs closely
In patients with mild to moderate hepatic cirrhosis (Child–Pugh A and B) the standard loading dose should be used followed by half the maintenance dose.
There is no data in patients with severe chronic hepatic cirrhosis
No Human Data – Animal Data Suggest Risk