section name header

Pronunciation

vor-i-KON-a-zole

Classifications

Therapeutic Classification: antifungals

Pharmacologic Classification: azoles

Indications

REMS


Action

  • Inhibits fungal ergosterol synthesis leading to production of abnormal fungal plasma membrane.
Therapeutic effects:
  • Antifungal activity.

Spectrum:

Pharmacokinetics

Absorption: 96% absorbed following oral administration; IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Primarily metabolized by liver via the CYP2C19, CYP2C9, and CYP3A4 isoenzymes; <2% excreted unchanged in urine. The CYP2C19 isoenzyme exhibits genetic polymorphism; 15–20% of Asian patients and 3–5% of Caucasian and Black patients may be poor metabolizers and may have significantly voriconazole concentrations and an risk of adverse effects.

Half-Life: Dose-dependent (adults: 6–9 hr); in hepatic impairment.

Time/Action Profile

(plasma concentrations)

ROUTEONSETPEAKDURATION
POrapid1–2 hr12 hr
IVrapidend of infusion12 hr



Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: changes in BP, peripheral edema, QT interval prolongation, tachycardia

Derm: DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), MELANOMA, photosensitivity, rash, SQUAMOUS CELL CARCINOMA, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS

EENT: visual disturbances, eye hemorrhage

Endo: ADRENAL INSUFFICIENCY

F and E: hyperglycemia, hypokalemia, hypomagnesemia

GI: abdominal pain, diarrhea, HEPATOTOXICITY, nausea, pancreatitis, vomiting

MS: fluorosis, periostitis

Neuro: dizziness, hallucinations, headache

Misc: chills, fever, infusion reactions

Interactions

Drug-drug:

Drug-Natural Products:

Route/Dosage

Invasive Aspergillosis, Scedosporiosis, or Fusariosis

Hepatic Impairment

Candidemia in Non-Neutropenic Patients or Other Deep Tissue Candida Infections

Hepatic Impairment

Esophageal Candidiasis

Hepatic Impairment

Availability

(Generic available)

Assessment

Lab Test Considerations:

Implementation

IV Administration:

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

Vfend

Code

NDC Code