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Voriconazole

Voriconazole IV

KEY POINTS

  • Voriconazole (VFend) is an “azole” antifungal drug that interferes with ergosterol synthesis, which leads to inhibition of fungal cell membrane formation
  • Widely considered the drug of choice for Aspergillus infections, but has activity versus many fungi, including a number of Candida species
  • Available as IV or PO
    • Commonly weight-based dosing, rounded to nearest 50mg then adjust per levels
    • With CrCl < 50 mL/min the IV product can lead to accumulation of cyclodextran, which may have negative effects on the kidneys
  • Monitor levels to ensure efficacy / avoid toxicity
    • Typical goal level range is 1 to 5 mcg/mL
    • Typical to take first level on day 5 as a trough (prior to the dose)
      • Levels above 5.5 mcg/mL associated with toxicity
  • Beware drug-drug interactions via CYP-450 system
  • Common toxicities include hepatotoxicity, hallucinations (especially with high levels) and visual disturbances

RESOURCES

  • Voriconazole Package Insert (IV & PO)
  • 2016 IDSA Aspergillus Guideline
  • 2016 IDSA Candidiasis Guideline
  • 2015 Review of Voriconazole Level Monitoring
  • 2006 Pharmacology of Systemic Antifungal Agents
  • Voriconazole Page on AIDSinfo.gov
  • Voriczonazole Drug Interactions AIDSinfo.gov

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