Monograph Details
|
|
Infections & Infestations
> Fungal infections
|
|
VFEND ORAL SUSPENSION |
| Manufacturer |
|
Pfizer Labs |
| Legal Classification |
|
Rx
|
| Pharmacological Class |
|
Azole. |
| Generic Name |
|
Voriconazole 40mg/mL; pwd for reconstitution; orange flavor. |
| Also |
• VFEND
• VFEND I.V. for INJECTION
|
| Indications |
|
Invasive aspergillosis. Nonneutropenic candidemia. Candida infections in abdomen, kidney, bladder, wounds, or skin (disseminated). Esophageal candidiasis. Serious infections caused by Scedosporium apiospermum and Fusarium species in patients refractory to, or intolerant of, other agents. |
| Children |
|
Not recommended. |
| Adults |
|
See literature. Infuse IV over 1–2 hours; max rate 3mg/kg per hour. Aspergillosis, other serious infections: initially 6mg/kg IV every 12 hours for 2 doses, then 4mg/kg every 12 hours. Candidemia, other deep tissue candida infections: initially 6mg/kg IV every 12 hours for 2 doses, then 3–4mg/kg every 12 hours; treat for at least 14 days after symptoms resolve or following last positive culture, whichever is longer. Both: switch to oral form when tolerated; give 1 hour before or after meals. Oral forms: <40kg: 100mg every 12 hours; may increase to 150mg every 12 hours if inadequate response; ≥40kg: 200mg every 12 hours; may increase to 300mg every 12 hours if inadequate response. Esophageal candidiasis: oral forms: <40kg: 100mg every 12 hours; ≥40kg: 200mg every 12 hours; treat for at least 14 days and for at least 7 days after symptoms resolve. Concomitant efavirenz: increase voriconazole dose to 400mg every 12 hours and decrease efavirenz dose to 300mg every 24 hours. Concomitant phenytoin: increase voriconazole dose. Hepatic impairment (mild to moderate): reduce maintenance dose by ½, (severe): see literature. Renal impairment (CrCl <50mL/min): oral forms preferred. Duration of therapy, and for dose adjustments if not tolerated: see literature. |
| Contraindications |
|
Concomitant quinidine, sirolimus, rifampin, rifabutin, carbamazepine, long-acting barbiturates, ergot alkaloids, pimozide, cisapride, efavirenz (adjusted dose may be used; see Adult dose); ritonavir 400mg every 12 hours. |
| Precautions |
|
Hepatic or renal dysfunction. Proarrhythmic conditions. Correct electrolyte disturbances before starting. Monitor visual function if used >28 days; hepatic function (at baseline and during therapy; consider discontinuing if hepatic dysfunction develops); and renal function (see literature). May cause visual disturbances; do not drive at night. Avoid strong sunlight. Pregnancy (Cat.D): use appropriate contraception. Nursing mothers: not recommended. |
| Interactions |
|
See Contraindications. Potentiates cyclosporine, tacrolimus, phenytoin, coumarin anticoagulants, methadone, other CYP3A4, CYP2C9, or CYP2C19 substrates (eg, triazolam, midazolam, alprazolam, vinca alkaloids, statins, NNRTIs, HIV protease inhibitors, calcium channel blockers, omeprazole, sulfonylureas). Antagonized by phenobarbital, phenytoin, possibly delavirdine, efavirenz, other CYP3A4 inducers. Monitor levels and/or effects of cyclosporine, tacrolimus, phenytoin, warfarin, sulfonylureas, HIV protease inhibitors, NNRTIs, vinca alkaloids, statins. May need dose adjustments; monitor closely. |
| Adverse Reactions |
|
Visual disturbances, GI upset, abdominal pain, rash (eg, Stevens-Johnson syndrome), fever, headache, sepsis, edema, hepatotoxicity, cardiovascular or CNS effects, hypokalemia, infusion reactions. |
| How Supplied |
Tabs—30
Susp—75mL (w. dispenser)
Vials—1 |
| Additional Resources |
|
• Related Prescribing Note |
|
|
|
|
