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