Adult Dosing
Invasive Aspergillosis
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 4 mg/kg IV q12 hrs. Alt: may switch to oral route
Serious fungal infections
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 4 mg/kg IV q12 hrs. Alt: may switch to oral route
Candidemia, non-neutropenic patients
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 3-4 mg/kg IV q12 hrs. Alt: may switch to oral route
- Treat for atleast 14 days following resolution of symptoms or following last positive culture
Deep tissue candidiasis
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 3-4 mg/kg IV q12 hrs. Alt: may switch to oral route
- Treat for atleast 14 days following resolution of symptoms or following last positive culture
Scedosporiosis and fusariosis
- Loading dose: 6 mg/kg IV q12 hours for 2 doses
- Maintenance dose: 4 mg/kg IV q12 hours
Pediatric Dosing
Note: Safety and effectiveness in pediatric patients below the age of 12 years have not been established
Invasive Aspergillosis
Child (12-18 yrs)
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 4 mg/kg IV q12 hrs. Alt: may switch to oral route
Serious fungal infections
Child (12-18 yrs)
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 4 mg/kg IV q12 hrs. Alt: may switch to oral route
Candidemia, non-neutropenic patients
Child (12-18 yrs)
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 3-4 mg/kg IV q12 hrs. Alt: may switch to oral route
- Treat for atleast 14 days following resolution of symptoms or following last positive culture
Deep tissue candidiasis
Child (12-18 yrs)
- Loading dose: 6 mg/kg IV q12 hrs for 2 doses
- Maintenance dose: 3-4 mg/kg IV q12 hrs. Alt: may switch to oral route
- Treat for atleast 14 days following resolution of symptoms or following last positive culture
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <50 mL/min: Accumulation of the intravenous vehicle (cyclodextrin) occurs. After initial I.V. loading dose, oral voriconazole should be administered to these patients, unless an assessment of the benefit:risk to the patient justifies the use of I.V. voriconazole
- Hemodialysis: No supplement
Hepatic Dose Adjustment
- Mild/moderate hepatic dysfunstion (Child-Pugh Class A/B): Following standard loading dose, reduce maintenance dosage by 50%
- Severe hepatic impairment (Child-Pugh Class C): Should only be used if benefit outweighs risk; monitor closely for toxicity
- Chronic hepatitis B or C: Dose adjustment not defined
- Voriconazole can cause prolongation of the QT interval especially in patients w/ hx of cardiotoxic chemotherapy, cardiomyopathy, hypokalemia and concomitant medications that increase QT interval. Maintain electrolyte balance
- Rare cases of hepatotoxicity including clinical hepatitis, cholestasis and fulminant hepatic failure, have been reported. Monitor LFTs at baseline and periodically thereafter
- Injection should not be given as a bolus
- IV infusion may cause anaphylactoid-type reactions
- Prolonged visual adverse events, including optic neuritis and papilledema may occur if therapy > 28 days. Monitor visual function including visual acuity, visual field and color perception
- Monitor serum creatinine at baseline and periodically thereafter
Cautions: Use cautiously in
- Mild to moderate hepatic impairment
- Renal impairment (avoid use if CrCl < 50 mL/min)
- Cardiotoxic chemotherapy
- Cardiomyopathy
- Hypokalemia
- Electrolyte abnormality
- QT prolongation risk factors
- Congenital QT syndrome
- Concurrent use of QT prolonging agents
- Hematologic malignancy
- Long term use
Pregnancy Category:D
Breastfeeding: Safety unknown; it should not be used unless benefit outweighs risk
