Voriconazole
General Information
Triazole antifungal
Restricted formulary antimicrobial: For details see OUH netFormulary
For all information regarding contra-indications, interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).
Standard dose
Note: For haemato-oncology patients see management and prevention of invasive fungal infection (IFI) in adult haemato-oncology patients guideline
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Weight
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Oral voriconazole
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IV voriconazole
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Weight less than 40kg |
Loading dose: 200mg po bd for 24 hours Maintenance dose: 100mg po bd
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Loading dose: 6mg/kg iv bd for 24 hours Maintenance dose: 4mg/kg iv bd
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Weight 40kg and above
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Loading dose: 400mg po bd for 24 hours Maintenance dose: 200mg po bd
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Obesity
Intravenous: Use ideal body weight to calculate dose. Carry out therapeutic drug monitoring.
Renal and hepatic impairment
Renal impairment
- Oral: No dose adjustment required
- IV: No dose adjustment required. If creatinine clearance is less than 50 mL/min accumulation of the intravenous vehicle sulfobutylether-β-cyclodextrin (SBECD) can occur.
- Consider if oral voriconazole can be used. Oral voriconazole has up to 96% bioavailability if taken on an empty stomach.
- If IV used, monitor serum creatinine and if increases occur review use of IV voriconazole and consider changing to oral voriconazole or alternative antifungal. Discuss with Micro/ID.
Hepatic impairment
- Mild to moderate hepatic cirrhosis (Child-Pugh A and B): Use standard loading dose and then half the maintenance dose.
- Severe hepatic cirrhosis (Child-Pugh C): Voriconazole has not been studied in this group of patients. Use only if the benefit outweighs the potential risk. Monitor patient for side effects.
Therapeutic Drug Monitoring
Therapeutic Drug Monitoring is required. See Therapeutic Drug Monitoring (TDM) for Antifungal Agents
MHRA Drug Safety Updates
MHRA Drug Safety update (December 2014) Voriconazole: reminder of risk of liver toxicity, phototoxicity, and squamous cell carcinoma'
- Alert has information for healthcare professionals which includes monitoring and counselling for patients. There is also a link to the Patient Alert Card
Additional information
The OUH Antifungal Patient Information Leaflet can be found HERE
References
- Pfizer Limited. Summary of Product Characteristics. Voriconazole Pfizer 200mg powder for solution for infusion [online]. Last revision of the text: 5/23. Accessed via: www.emc.medicines.org.uk Accessed 21/3/25
- Pfizer Limited. Summary of Product Characteristics. Vfend 200mg film-coated tablets [online]. Last revision of the text: 11/24. Accessed via: www.emc.medicines.org.uk Accessed 21/3/25
- Pfizer Limited. Summary of Product Characteristics. Vfend 40mg/ml powder for oral suspension [online]. Last revision of the text: 09/24. Accessed via: www.emc.medicines.org.uk Accessed 21/3/25
- The Renal Drug Database. Voriconazole. [online]. Last updated: 29/10/24. Accessed via: https://renaldrugdatabase.com Accessed 21/3/25
- Sanford Guide. Voriconazole [Internet] Last updated: 18/2/25. Accessed 21/3/25
- Sanford Guide. Obesity dosing adjustment [Internet] Last updated: December 2024. Accessed 21/3/25
- Luke, David R et al. “Review of the basic and clinical pharmacology of sulfobutylether-beta-cyclodextrin (SBECD).” Journal of pharmaceutical sciences vol. 99,8 (2010): 3291-301. doi:10.1002/jps.22109
- Eljaaly, K., & Nix, D. E. (2016). Voriconazole Dosing in Obese Patients. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 63(2), 286–287. https://doi.org/10.1093/cid/ciw252