Voriconazole

Table of contents

  • Brand Names
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Unlabeled Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Caution and personalized dose adjustment in patients with the following genotypes
  • Other genes that may be involved
  • Substrate of
  • Inhibits
  • Drug Interactions
  • Nutrition/Nutraceutical Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names

Europe

Austria: Vfend; Belgium: Vfend; Czech Republic: Vfend; Denmark: Vfend; Estonia: Vfend; Finland: Vfend; France: Vfend; Germany: Vfend; Greece: Vfend; Hungary: Vfend; Ireland: Vfend; Italy: Vfend; Latvia: Vfend; Lithuania: Vfend; Luxembourg: Vfend; Netherlands: Vfend; Poland: Vfend; Portugal: Vfend; Romania: Vfend; Slovakia: Vfend; Spain: Vfend; Sweden: Vfend; UK: Vfend.

North America

Canada: Vfend; USA: Vfend.

Latin America

Argentina: Vfend; Brazil: Vfend; Mexico: Vfend.

Asia

Japan: Vfend.

Drug combinations

Chemistry

Voriconazole: C~16~H~14~F~3~N~5~O. Mw: 349.31. (1) 4-Pyrimidineethanol, α-(2,4-difluorophenyl)-5-fluoro-β-methyl-α-(1H-1,2,4-triazol-1-ylmethyl)-, (αR,βS)-; (2)(αR,βS)-α-(2,4-Difluorophenyl)-5-fluoro-β-methyl-α-(1H-1,2,4-triazol-1-ylmethyl)-4-pyrimidineethanol. CAS-137234-62-9 (1999).

Pharmacologic Category

Antifungals; Azoles. Oral Antifungal Agent. Parenteral Antifungal Agent. (ATC-Code: J02AC03).

Mechanism of action

Interferes with fungal cytochrome P450 activity (selectively inhibits 14-α-lanosterol demethylation), decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting fungal cell membrane formation.

Therapeutic use

Treatment of invasive aspergillosis, esophageal candidiasis, candidemia (in non-neutropenic patients), disseminated Candida infections of skin and viscera, serious fungal infections caused by Scedosporium apiospermum and Fusarium spp. (including Fusarium solani).

Pregnancy and lactiation implications

Can cause fetal harm when administered to a pregnant woman. Voriconazole was teratogenic and embryotoxic in animal studies, and lowered plasma estradiol in animal models. Should be used in pregnant women only if benefit to mother justifies potential risk to fetus. Not recommended in nursing women.

Unlabeled use

Fungal infection prophylaxis in intermediate- or high-risk neutropenic cancer patients with myelodysplastic syndrome or acute myelogenous leukemia, neutropenic allogeneic hematopoietic stem cell recipients, and significant graft vs host disease. Empiric antifungal therapy (second-line) for persistent neutropenic fever.

Contraindications

Hypersensitivity to voriconazole or any component of the formulation. Co-administration of CYP3A4 substrates which may lead to QTc prolongation (cisapride, pimozide, quinidine). Co-administration with barbiturates (long-acting), carbamazepine, efavirenz (with standard voriconazole and efavirenz doses), ergot derivatives, rifampin, rifabutin, ritonavir (≥800 mg/day), sirolimus, St. John’s wort.

Warnings and precautions

QT interval prolongation might occur. Rare cases of arrhythmia (including torsade de pointes), cardiac arrest, and sudden death reported, usually in seriously ill patients with comorbidities and/or risk factors (e.g. prior cardiotoxic chemotherapy, cardiomyopathy, electrolyte imbalance, or concomitant QTc-prolonging drugs). Rarely, serious cutaneous reactions, including Stevens-Johnson syndrome, reported with treatment. May cause photosensitivity (especially with long-term use). Visual and/or auditory hallucinations observed. Ocular effects (blurred vision, changes in visual acuity, color perception, and photophobia), commonly associated with treatment. Serious (and rarely fatal) hepatic toxicity (e.g. hepatitis, cholestasis, fulminant failure) observed with azole therapy (use with caution in pre-existing hepatic impairment). Postmarketing reports of pancreatitis in children exist. High potential for CYP-mediated interactions. Avoid or limit use of intravenous formulation in renal impairment (contains excipient sulfobutyl ether β-cyclodextrin, which may accumulate in renal insufficiency). Anaphylactoid-type infusion-related reactions may occur with intravenous dosing. Tablets contain lactose (avoid administration in hereditary galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption). Suspension contains sucrose (use caution with fructose intolerance, sucrose-isomaltase deficiency, or glucose-galactose malabsorption).

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