Drug reference

Voriconazole

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 657, 658

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Invasive aspergillosis | Serious infections caused by Scedosporium spp., Fusarium spp., or invasive fluconazole-resistant Candida spp. (including C. krusei) ▶BY MOUTH ▶Adult (body-weight up to 40 kg): Initially 200 mg every 12 hours for 2 doses, then 100 mg every 12 hours, increased if necessary to 150 mg every 12 hours ▶Adult (body-weight 40 kg and above): Initially 400 mg every 12 hours for 2 doses, then 200 mg every 12 hours, increased if necessary to 300 mg every 12 hours ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg every 12 hours; reduced if not tolerated to 3 mg/kg every 12 hours; for max. 6 months

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Dose Adjustments

DUE TO INTERACTIONS ▶With intravenous use Manufacturer advises increase maintenance dose to 5 mg/kg every 12 hours with concurrent use of fosphenytoin, phenytoin or rifabutin. ▶With oral use Manufacturer advises increase maintenance dose with concurrent use of fosphenytoin or phenytoin; 400 mg every 12 hours for patients of body-weight 40 kg and above; 200 mg every 12 hours for patients of body-weight less than 40 kg. Manufacturer advises if concurrent use of rifabutin is unavoidable, increase maintenance dose to 350 mg every 12 hours for patients of body-weight 40 kg and above; 200 mg every 12 hours for patients of body- weight less than 40 kg.

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Contra Indications

Acute porphyrias p. 1120

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Cautions

Avoid exposure to sunlight. bradycardia. cardiomyopathy. electrolyte disturbances. history of QT interval prolongation. patients at risk of pancreatitis. symptomatic arrhythmias

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Prescribing And Dispensing Information

Flavours of oral liquid formulations may include orange.

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Safety

Interactions

→Appendix 1: antifungals, azoles

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Side Effects

GENERAL SIDE-EFFECTS ▶Common or very common Acute kidney injury. agranulocytosis. alopecia. anaemia. anxiety. arrhythmias . asthenia. bone marrow disorders. chest pain. chills. confusion. constipation. depression. diarrhoea. dizziness . drowsiness. dyspnoea. electrolyte imbalance. eye disorders. eye inﬂammation. fever. gastrointestinal discomfort. haemorrhage. hallucination. headache. hepatic disorders. hypoglycaemia. hypotension. increased risk of infection. insomnia. leucopenia. muscle tone increased. nausea. neutropenia. oedema. oral disorders. pain. pulmonary oedema. respiratory disorders . seizure. sensation abnormal. skin reactions. syncope. tetany. thrombocytopenia. tremor. vision disorders. vomiting ▶Uncommon Adrenal insufﬁciency. arthritis. brain oedema . duodenitis. encephalopathy. eosinophilia. gallbladder disorders. hearing impairment. hypothyroidism. inﬂuenza like illness. lymphadenopathy. lymphangitis. movement disorders. nephritis. nerve disorders. pancreatitis. parkinsonism. phototoxicity. proteinuria. pseudomembranous enterocolitis. QT interval prolongation. renal tubular necrosis. severe cutaneous adverse reactions (SCARs). taste altered. thrombophlebitis. tinnitus. vertigo ▶Rare or very rare Angioedema. cardiac conduction disorders. disseminated intravascular coagulation. Infection hyperthyroidism ▶Frequency not known Cutaneous lupus erythematosus. periostitis (more common in transplant patients). squamous cell carcinoma (more common in presence of phototoxicity) SPECIFIC SIDE-EFFECTS ▶With intravenous use Infusion related reaction SIDE-EFFECTS, FURTHER INFORMATION Hepatotoxicity Hepatitis, cholestasis, and acute hepatic failure have been reported; risk of hepatotoxicity increased in patients with haematological malignancy. Consider treatment discontinuation if severe abnormalities in liver function tests. Phototoxicity Phototoxicity occurs uncommonly. If phototoxicity occurs, consider treatment discontinuation; if treatment is continued, monitor for pre-malignant skin lesions and squamous cell carcinoma, and discontinue treatment if they occur.

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Conception And Contraception

Effective contraception required during treatment.

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Pregnancy

Toxicity in animal studies—manufacturer advises avoid unless potential beneﬁt outweighs risk.

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Breast Feeding

Manufacturer advises avoid—no information available.

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Hepatic Impairment

Manufacturer advises caution, particularly in severe impairment (no information available). Dose adjustments Manufacturer advises use usual initial loading dose then halve maintenance dose in mild to moderate cirrhosis.

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Renal Impairment

Intravenous vehicle may accumulate if eGFR less than 50 mL/minute/1.73 m2—use intravenous infusion only if potential beneﬁt outweighs risk, and monitor renal function; alternatively, use tablets or oral suspension (no dose adjustment required).

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Monitoring Requirements

▶Monitor renal function. ▶Monitor liver function before starting treatment, then at least weekly for 1 month, and then monthly during treatment.

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Dose and formulations

Directions For Administration

▶With intravenous use For intravenous infusion, reconstitute each 200 mg with 19 mL Water for Injections or Sodium Chloride 0.9% to produce a 10 mg/mL solution; dilute dose to concentration of 0.5–5 mg/mL with Glucose 5% or Sodium Chloride 0.9% and give intermittently at a rate not exceeding 3 mg/kg/hour.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion EXCIPIENTS: May contain Sulfobutylether beta cyclodextrin sodium ELECTROLYTES: May contain Sodium ▶Voriconazole (Non-proprietary) Infection Voriconazole 200 mg Voriconazole 200mg powder for solution for infusion vials | 1 vial P £51.43–£77.14 (Hospital only) ▶VFEND (Pfizer Ltd) Voriconazole 200 mg VFEND 200mg powder for solution for infusion vials | 1 vial P £77.14 (Hospital only) Oral suspension CAUTIONARY AND ADVISORY LABELS 9, 11, 23 ▶VFEND (Pfizer Ltd) Voriconazole 40 mg per 1 ml VFEND 40mg/ml oral suspension | 75 ml P £551.37 DT = £551.37 Tablet CAUTIONARY AND ADVISORY LABELS 9, 11, 23 ▶Voriconazole (Non-proprietary) Voriconazole 50 mg Voriconazole 50mg tablets | 28 tablet P £275.68 DT = £162.68 | 28 tablet P £47.47 DT = £162.68 (Hospital only) Voriconazole 100 mg Voriconazole 100mg tablets | 28 tablet P £275.68 Voriconazole 200 mg Voriconazole 200mg tablets | 28 tablet P £164.58 DT = £635.34 (Hospital only) | 28 tablet P £1,102.74 DT = £635.34 ▶VFEND (Pfizer Ltd) Voriconazole 50 mg VFEND 50mg tablets | 28 tablet P £275.68 DT = £162.68 Voriconazole 200 mg VFEND 200mg tablets | 28 tablet P £1,102.74 DT = £635.34 ANTIFUNGALS › OTHER

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Clinical care

Patient And Carer Advice

Patients and their carers should be told how to recognise symptoms of liver disorder, and advised to seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop. Patients and their carers should be advised that patients should avoid intense or prolonged exposure to direct sunlight, and to avoid the use of sunbeds. In sunlight, patients should cover sun-exposed areas of skin and use a sunscreen with a high sun protection factor. Patients should seek medical attention if they experience sunburn or a severe skin reaction following exposure to light or sun. Patients and their carers should be advised to keep the alert card with them at all times.

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Dose text by age group

Adult (body-weight up to 40 kg)

Initially 200 mg every

First-line fragment. Read the complete Indications and Dose section above.

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Adult (body-weight 40 kg and above)

Initially 400 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 657

Adult

Initially 6 mg/kg every 12 hours for 2 doses, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 657

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Voriconazole

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 657, 658

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 657

Dose Adjustments

PDF page 657

Contra Indications

Acute porphyrias p. 1120

PDF page 657

Cautions

Avoid exposure to sunlight. bradycardia. cardiomyopathy. electrolyte disturbances. history of QT interval prolongation. patients at risk of pancreatitis. symptomatic arrhythmias

PDF page 657

Prescribing And Dispensing Information

Flavours of oral liquid formulations may include orange.

PDF page 657

Safety

Interactions

→Appendix 1: antifungals, azoles

PDF page 657

Side Effects

PDF page 657

Conception And Contraception

Effective contraception required during treatment.

PDF page 657

Pregnancy

Toxicity in animal studies—manufacturer advises avoid unless potential beneﬁt outweighs risk.

PDF page 657

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 657

Hepatic Impairment

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Renal Impairment

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Monitoring Requirements

▶Monitor renal function. ▶Monitor liver function before starting treatment, then at least weekly for 1 month, and then monthly during treatment.

PDF page 657

Dose and formulations

Directions For Administration

PDF page 657

Medicinal Forms

PDF page 658

Clinical care

Patient And Carer Advice

PDF pages 657, 658

Dose text by age group

Adult (body-weight up to 40 kg)

Initially 200 mg every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 657

Adult (body-weight 40 kg and above)

Initially 400 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 657

Adult

Initially 6 mg/kg every 12 hours for 2 doses, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 657

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.