{"id":4469,"date":"2025-03-31T18:12:09","date_gmt":"2025-03-31T18:12:09","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/voriconazole-txt\/"},"modified":"2025-03-31T18:12:09","modified_gmt":"2025-03-31T18:12:09","slug":"voriconazole-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/voriconazole-txt\/","title":{"rendered":"Voriconazole.txt"},"content":{"rendered":"

CLINICAL USE <\/H3> Antifungal: Invasive aspergillosis Fluconazole-resistant serious invasive fungal infections Immunocompromised patients with progressive, possibly life-threatening infections

DOSE IN NORMAL RENAL FUNCTION <\/H3> IV: 6 mg\/kg 12 hourly for 24 hours, then 3\u20134 mg\/kg 12 hourly Oral: 40 kg, 400 mg 12 hourly for 24 hours, then 200\u2013300 mg twice daily

PHARMACOKINETICS <\/H3>
  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 349.3 <\/li>\n
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 58 <\/li>\n
  • %Excreted unchanged in urine &nbsp &nbsp : <2 <\/li>\n

  • Volume of distribution (L\/kg) &nbsp &nbsp &nbsp : 4.6 <\/li>\n

  • half-life \u2013 normal\/ESRD (hrs)&nbsp &nbsp &nbsp : 6 (depends on dose)\/ Unchanged

    DOSE IN RENAL IMPAIRMENT <\/H3>

    GFR (mL\/MIN)<\/H4>
  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function. See \u2018Other Information\u2019

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES <\/H3>
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: Probably dialysed. Dose as in normal renal function <\/p>\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Dialysed. Dose as in normal renal function
  • HDF\/high flux &nbsp : Dialysed. Dose as in normal renal function
  • CAV\/VVHD &nbsp &nbsp &nbsp: Probably dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS <\/H3> Potentially hazardous interactions with other drugs\n
  • Analgesics: methadone concentration increased\n
  • Antibacterials: concentration reduced by rifabutin; increase dose of voriconazole from 200 to 350 mg and from 100 to 200 mg (depends on patient\u2019s weight), and increase IV dose to 5 mg\/kg if used in combination \u2013 avoid concomitant use if possible; increased rifabutin levels \u2013 monitor for toxicity; avoid concomitant use with rifampicin\n
  • Anticoagulants: enhanced effect of coumarins\n
  • Antidepressants: avoid concomitant use with reboxetine Antidiabetics: possibly increased concentration of sulphonylureas\n
  • Anti-epileptics: concentration reduced by carbamazepine, barbiturates and primidone \u2013 avoid concomitant use; phenytoin reduces voriconazole concentration and voriconazole increases phenytoin concentration \u2013 double oral voriconazole dose and increase IV to 5 mg\/ kg dose if using with phenytoin; avoid concomitant use if possible\n
  • Antimalarials: avoid concomitant use with artemether\/lumefantrine\n
  • Antipsychotics: increased risk of ventricular arrhythmias with pimozide and sertindole \u2013 avoid concomitant use; possibly increased quetiapine levels \u2013 reduce dose of quetiapine\n
  • Antivirals: concentration reduced by efavirenz and ritonavir; also concentration of efavirenz increased \u2013 avoid concomitant use with ritonavir; with efavirenz reduce dose by 50% and increase dose of voriconazole to 400 mg twice daily; possibly increased saquinavir levels Benzodiazepines: may inhibit metabolism of midazolam\n
  • Ciclosporin: AUC increased \u2013 reduce ciclosporin dose by 50% and monitor closely\n
  • Ergot alkaloids: risk of ergotism \u2013 avoid concomitant use Lipid-lowering drugs: possibly increased risk of myopathy with atorvastatin or simvastatin . Sirolimus: increased sirolimus concentration \u2013 avoid concomitant use\n
  • Tacrolimus: AUC increased \u2013 reduce tacrolimus dose to a third and monitor closely\n
  • Ulcer-healing drugs: omeprazole concentration increased \u2013 reduce omeprazole dose by 50%

    ADMINISTRATION <\/H3>

    Reconstition<\/H4> 19 mL water for injection

    Route <\/H4> Oral, IV

    Rate of Administration <\/H4> 1\u20132 hours (3 mg\/kg\/hour)

    Comments<\/H4> Not compatible with sodium bicarbonate or TPN solutions Dilute to a concentration of 2\u20135 mg\/mL with sodium chloride 0.9%, Hartmann\u2019s solution or glucose 5%

    OTHER INFORMATION <\/H4> Haemodialysis clearance is 121 mL\/min Oral bioavailability is 96% Only use IV in renal patients if patient is unable to tolerate oral, as intravenous vehicle (SBECD) accumulates in renal failure. The vehicle is dialysed at a rate of 55 mL\/min Take oral dose 1 hour before or an hour after meals Monitor renal function as can enhance nephrotoxicity of other drugs and concurrent conditions Rare reports of acute renal failure and discoid lupus erythematosus occurring Also reports of haematuria, nephritis and tubular necrosis In clinical trials, 30% of patients had visual problems, usually with higher doses .
    \n","protected":false},"excerpt":{"rendered":"

    CLINICAL USE Antifungal: Invasive aspergillosis Fluconazole-resistant serious invasive fungal infections<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-4469","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/4469","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=4469"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/4469\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=4469"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=4469"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=4469"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}