VFEND

Voriconazole

Invasive aspergillosis; candidemia in non-neutropenic patients; serious invasive Candida infections including C. krusei; esophageal candidiasis; serious fungal infections caused by Scedosporium apiospermum & Fusarium sp including Fusarium solani, in patients intolerant of, or refractory to, other therapy.

Tab May be given once the patient can tolerate medication given PO. Adult & adolescent (12-16 yr), Patient >40 kg Maintenance dose: 200 mg 12 hrly. Dose may be increased to 300 mg 12 hrly if response is inadequate. Dose may be reduced by 50 mg steps to min of 200 mg 12 hrly if unable to tolerate treatment. Loading dose: 400 mg 12 hrly (for the 1st 24 hr). Patient <40 kg Maintenance dose: 100 mg 12 hrly. Dose may be increased to 150 mg 12 hrly if response is inadequate. Dose may be reduced by 50 mg steps to min of 100 mg 12 hrly if unable to tolerate treatment. Loading dose: 200 mg 12 hrly (for the 1st 24 hr). Childn ≥2 yr Maintenance dose: 200 mg twice daily. Co-administration w/ phenytoin Increase oral maintenance dose to 400 mg 12 hrly in patients >40 kg & 200 mg 12 hrly in patients <40 kg. Vial By IV infusion only. Max rate: 3 mg/kg/hr over 1-2 hr. Initiate treatment w/ a loading dose of 6 mg/kg 12 hrly for 2 doses, followed by a maintenance dose of 4 mg/kg 12 hrly. If patients are unable to tolerate treatment, reduce IV maintenance dose to 3 mg/kg 12 hrly.  Childn Maintenance dose: 7 mg/kg twice daily. If childn are unable to tolerate treatment, reduce IV maintenance dose to 4 mg/kg twice daily. Co-administration w/ phenytoin Increase IV maintenance dose to 5 mg/kg 12 hrly.

Should be taken on an empty stomach: Take at least 1 hr before or after meals.

Hypersensitivity.

Hypersensitivity to other azoles; patients w/ potentially proarryhthmic conditions; hematological malignancy or other serious underlying medical conditions. Monitor hepatic, pancreatic & renal function & dermatological reactions. Changes to vision. Avoid strong, direct sunlight during therapy. VFEND tab: Avoid use in patients w/ rare hereditary problems of galactose intolerance, Lapp-lactase deficiency or glucose-galactose malabsorption. May impair ability to drive or operate machinery. Pregnancy & lactation. Childn <2 yr.

Visual impairment, fever, chills, headache, abdominal pain, chest pain, tachycardia, HTN or hypotension, vasodilatation, GI disturbances, thrombocytopenia, anemia, leukopenia, pancytopenia, metabolic & nutritional disorders, hallucinations, dizziness, rash, pruritus, maculopapular rash, abnormal kidney function, acute kidney failure.

Do not co-administer w/ terfenadine, astemizole, cisapride, pimozide, quinidine, sirolimus, rifampicin, carbamazepine, long-acting barbiturates, rifabutin, ergot alkaloids (ergotamine, dihydroergotamine). Monitor when used w/ cyclosporine, tacrolimus, warfarin & other oral anticoagulants, sulfonylureas, statins, benzodiazepines, vinca alkaloids & Ca-channel blockers, short-acting opiates (CYP3A4 substrates). Dosage adjustments & monitoring required when used w/ phenytoin, omeprazole & other PPIs. Monitor for drug toxicity when HIV PIs or NNRTIs are co-administered. St. John's wort.

Antifungals

J02AC03 - voriconazole ; Belongs to the class of triazole and tetrazole derivatives. Used in the systemic treatment of mycotic infections.

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