Voriconazole (Oral)

October 27th, 2021 | drugs

Generic name: voriconazole (vor-i-KON-a-zole)
Drug class: Azole antifungals

Commonly used brand name(s)

In the U.S.

Vfend

Available Dosage Forms:

Powder for Suspension
Tablet

Therapeutic Class: Antifungal

Chemical Class: Triazole

Uses for voriconazole

Voriconazole is used to treat serious fungal or yeast infections, such as aspergillosis (fungal infection in the lungs), candidemia (fungal infection in the blood), esophageal candidiasis (candida esophagitis), or other fungal infections (infections in the skin, stomach, kidney, bladder, or wounds). It may also be used to treat patients with serious fungal or yeast infections who cannot tolerate or do not respond to other types of treatment.

Voriconazole is available only with your doctor's prescription.

Before using voriconazole

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For voriconazole, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to voriconazole or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of voriconazole in children younger than 2 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of voriconazole in the elderly.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking voriconazole, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using voriconazole with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Alprazolam
Astemizole
Bepridil
Carbamazepine
Cisapride
Colchicine
Conivaptan
Dihydroergotamine
Dronedarone
Efavirenz
Eletriptan
Eliglustat
Eplerenone
Ergoloid Mesylates
Ergonovine
Ergotamine
Finerenone
Flibanserin
Fluconazole
Isavuconazonium Sulfate
Ivabradine
Lomitapide
Lovastatin
Lurasidone
Maraviroc
Mephobarbital
Mesoridazine
Methylergonovine
Methysergide
Naloxegol
Nelfinavir
Nimodipine
Phenobarbital
Pimozide
Piperaquine
Posaconazole
Primidone
Quinidine
Rifabutin
Rifampin
Ritonavir
Saquinavir
Simvastatin
Sirolimus
Sparfloxacin
St John's Wort
Terfenadine
Thioridazine
Tolvaptan
Ubrogepant
Venetoclax
Voclosporin
Ziprasidone

Using voriconazole with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acalabrutinib
Acenocoumarol
Ado-Trastuzumab Emtansine
Alfentanil
Amiodarone
Amisulpride
Amitriptyline
Amoxapine
Anagrelide
Apalutamide
Apomorphine
Aprepitant
Aripiprazole
Aripiprazole Lauroxil
Arsenic Trioxide
Artemether
Asenapine
Avanafil
Avapritinib
Axitinib
Azithromycin
Bedaquiline
Benzhydrocodone
Boceprevir
Bosutinib
Brentuximab Vedotin
Bretylium
Brexpiprazole
Brigatinib
Bromocriptine
Buprenorphine
Buserelin
Cabazitaxel
Cabozantinib
Calcifediol
Cariprazine
Carvedilol
Ceritinib
Chloramphenicol
Chloroquine
Chlorpromazine
Cilostazol
Ciprofloxacin
Citalopram
Clarithromycin
Clofazimine
Clomipramine
Clozapine
Cobicistat
Cobimetinib
Codeine
Copanlisib
Crizotinib
Cyclobenzaprine
Cyclosporine
Dabrafenib
Daclatasvir
Dasabuvir
Dasatinib
Deflazacort
Degarelix
Delamanid
Delavirdine
Desipramine
Deslorelin
Deutetrabenazine
Dexamethasone
Dicumarol
Dihydrocodeine
Disopyramide
Docetaxel
Dofetilide
Dolasetron
Domperidone
Donepezil
Doxorubicin
Doxorubicin Hydrochloride Liposome
Droperidol
Duvelisib
Elagolix
Elexacaftor
Elvitegravir
Encorafenib
Entacapone
Entrectinib
Enzalutamide
Erlotinib
Erythromycin
Escitalopram
Eslicarbazepine Acetate
Eszopiclone
Everolimus
Fedratinib
Fentanyl
Fesoterodine
Fingolimod
Flecainide
Fluoxetine
Fluticasone
Formoterol
Fosaprepitant
Foscarnet
Fosphenytoin
Fostemsavir
Gatifloxacin
Gemifloxacin
Glasdegib
Glimepiride
Gonadorelin
Goserelin
Granisetron
Halofantrine
Haloperidol
Histrelin
Hydrocodone
Hydroxychloroquine
Hydroxyzine
Ibrexafungerp
Ibrutinib
Ibutilide
Idelalisib
Ifosfamide
Iloperidone
Imipramine
Infigratinib
Inotuzumab Ozogamicin
Irinotecan
Irinotecan Liposome
Istradefylline
Ivacaftor
Ivosidenib
Ixabepilone
Ketoconazole
Lansoprazole
Lapatinib
Larotrectinib
Lefamulin
Lemborexant
Lenvatinib
Letermovir
Levofloxacin
Levomilnacipran
Lofexidine
Lopinavir
Lorlatinib
Lumacaftor
Lumateperone
Lumefantrine
Lurbinectedin
Macimorelin
Macitentan
Manidipine
Mefloquine
Meperidine
Methadone
Methylprednisolone
Metronidazole
Midostaurin
Mifepristone
Mirtazapine
Moxifloxacin
Nafarelin
Neratinib
Nevirapine
Nifedipine
Nilotinib
Norfloxacin
Nortriptyline
Octreotide
Ofloxacin
Olaparib
Ombitasvir
Omeprazole
Ondansetron
Osilodrostat
Osimertinib
Oxaliplatin
Oxycodone
Ozanimod
Palbociclib
Paliperidone
Panobinostat
Paritaprevir
Pasireotide
Pazopanib
Pemigatinib
Pentazocine
Pexidartinib
Phenprocoumon
Phenytoin
Pimavanserin
Pitolisant
Ponatinib
Ponesimod
Pralsetinib
Procainamide
Prochlorperazine
Promethazine
Propafenone
Protriptyline
Quetiapine
Quinine
Ranolazine
Reboxetine
Regorafenib
Retapamulin
Ribociclib
Rimegepant
Romidepsin
Ruxolitinib
Salmeterol
Selpercatinib
Selumetinib
Sertraline
Sevoflurane
Sildenafil
Simeprevir
Siponimod
Sodium Phosphate
Sodium Phosphate, Dibasic
Sodium Phosphate, Monobasic
Solifenacin
Sonidegib
Sorafenib
Sotalol
Sufentanil
Sulpiride
Sunitinib
Suvorexant
Tacrolimus
Tamsulosin
Tazemetostat
Telaprevir
Telavancin
Telithromycin
Temsirolimus
Tetrabenazine
Tezacaftor
Thiotepa
Ticagrelor
Toremifene
Trabectedin
Tramadol
Trazodone
Triazolam
Triclabendazole
Trifluoperazine
Trimipramine
Triptorelin
Valbenazine
Vandetanib
Vardenafil
Vemurafenib
Vilanterol
Vilazodone
Vinblastine
Vincristine
Vincristine Sulfate Liposome
Vinflunine
Vinorelbine
Vorapaxar
Voxelotor
Warfarin
Zanubrutinib
Zolpidem
Zuclopenthixol

Using voriconazole with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Amprenavir
Atorvastatin
Cerivastatin
Desogestrel
Dienogest
Drospirenone
Esomeprazole
Estradiol
Ethinyl Estradiol
Ethynodiol
Etravirine
Fosamprenavir
Gestodene
Glipizide
Glyburide
Levonorgestrel
Meloxicam
Mestranol
Midazolam
Nomegestrol
Norethindrone
Norgestimate
Norgestrel
Tolbutamide
Tretinoin

Interactions with food/tobacco/alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Proper use of voriconazole

Take voriconazole exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Voriconazole comes with a patient information leaflet. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

It is best to take voriconazole at least 1 hour before or 1 hour after a meal.

Shake the oral liquid well before each use. Use the oral dispenser that comes with the package to measure the dose. Rinse the oral dispenser with water after each use.

Do not mix the oral liquid with any other medicine, liquid, or syrup.

Keep using voriconazole for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Dosing

The dose of voriconazole will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of voriconazole. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage forms (suspension or tablets):
- For fungal infections:
  - Adults, children 12 to 14 years of age weighing 50 kilograms (kg) or more, and children 15 years of age and older—At first, a loading dose of voriconazole injection is given by your doctor on the first 24 hours of treatment. Then, your doctor may switch you to an oral maintenance dose of 200 milligrams (mg) taken every 12 hours. Your doctor may adjust your dose as needed.
  - Adults weighing less than 40 kilograms (kg)—At first, a loading dose of voriconazole injection is given by your doctor on the first 24 hours of treatment. Then, your doctor may switch you to an oral maintenance dose of 100 or 150 milligrams (mg) taken every 12 hours. Your doctor may adjust your dose as needed.
  - Children 12 to 14 years of age weighing less than 50 kilograms (kg) and children 2 to 11 years of age—Dose is based on body weight and must be determined by your doctor. At first, a loading dose of voriconazole injection is given by your doctor on the first 24 hours of treatment. Then, your doctor may switch you to an oral maintenance dose of 9 milligrams (mg) per kg of body weight taken every 12 hours. Your doctor may adjust your dose as needed. However, the dose is usually not more than 350 mg every 12 hours.
  - Children younger than 2 years of age—Use is not recommended.

Missed dose

If you miss a dose of voriconazole, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not refrigerate or freeze the oral liquid. It should be kept at room temperature and used within 14 days.

Precautions while using voriconazole

It is very important that your doctor check your or your child's progress at regular visits to make sure that voriconazole is working properly. Blood and urine tests will be needed to check for unwanted effects.

If your or your child's symptoms do not improve, or if they become worse, check with your doctor. You may need to take voriconazole for several months before your infection gets better.

Using voriconazole while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

You or your child should not use astemizole (Hismanal®), barbiturates (eg, phenobarbital, Luminal®), carbamazepine (Tegretol®), cisapride (Propulsid®), efavirenz (Sustiva®), ergot medicines (eg, dihydroergotamine, ergotamine, Cafergot®, Ergomar®, Wigraine®), ivabradine (Corlanor®, Procoralan®), naloxegol (Movantik®), pimozide (Orap®), quinidine (Quinaglute®), rifabutin (Mycobutin®), rifampin (Rifadin®, Rimactane®), ritonavir (Norvir®), sirolimus (Rapamune®), St. John's wort, terfenadine (Seldane®), tolvaptan (Jynarque®, Samsca®), or venetoclax (Venclexta®). Using any of them together with voriconazole may increase the chance of unwanted effects.

Voriconazole may cause vision problems. Do not drive (especially at night) or do anything else that could be dangerous until you know how voriconazole affects you. Call your doctor if you or your child have any vision changes or if bright lights bother your eyes.

Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Voriconazole tablets contain lactose (milk sugar) while the oral liquid contains sucrose (table sugar), which can make patients with conditions that make it hard for them to digest sugars or dairy products worse. Talk to your doctor if you or your child have concerns about this.

Contact your doctor right away if you or your child have any changes to your heart rhythm. You might feel dizzy or faint, or you might have a fast, pounding, or uneven heartbeat. Make sure your doctor knows if you or anyone in your family has ever had a heart rhythm problem, including QT prolongation.

Voriconazole may increase your or your child's risk of having kidney problems, including acute kidney failure. Check with your doctor right away if you have blood in the urine, decreased urine output, muscle twitching, nausea, rapid weight gain, seizures, decreased awareness or responsiveness, severe sleepiness, swelling of the face, ankles, or hands, or unusual tiredness or weakness.

Voriconazole may cause serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS). Check with your doctor right away if you or your child have black, tarry stools, blistering, peeling, loosening of the skin, chest pain, chills, cough, diarrhea, fever, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, painful or difficult urination, swollen glands. trouble breathing, unusual bleeding, bruising, tiredness, or weakness.

Pancreatitis (swelling of the pancreas) may occur while you or your child are using voriconazole. Check with your doctor right away if you or your child have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.

Voriconazole may make your or your child's skin more sensitive to sunlight. Use sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Voriconazole may cause adrenal gland problems. Check with your doctor right away if you or your child have darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.

Voriconazole may cause bone pain when used for a long period of time. Check with your doctor right away if you or your child have bone pain while using voriconazole.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Voriconazole side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Black, tarry stools
blistering, peeling, loosening of the skin
chest pain
chills
cough
diarrhea
difficulty seeing at night
fever
increased sensitivity of the eyes to sunlight
itching, rash
joint or muscle pain
painful or difficult urination
red irritated eyes
red skin lesions, often with a purple center
sore throat
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
trouble breathing
unusual bleeding or bruising
unusual tiredness or weakness
vision changes

Less common

Bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
chills
clay-colored stools
confusion
dark urine
decreased urine
dizziness
dry mouth
faintness or lightheadedness when getting up suddenly from a lying or sitting position
feeling of warmth
increased thirst
irregular or pounding heartbeat
loss of appetite
muscle pain or cramps
muscle spasms or twitching
nausea
nervousness
numbness or tingling in the hands, feet, or lips
pounding in the ears
rapid weight gain
rash with flat lesions or small raised lesions on the skin
redness of the face, neck, arms, and occasionally, the upper chest
seizures
stomach pain
slow or fast heartbeat
sweating
trembling
unpleasant breath odor
vomiting of blood
yellow eyes or skin

Rare

Agitation
blistering, peeling, or loosening of the skin
hostility or anger
increased sensitivity of the skin to sunlight
irritability
redness or other discoloration of the skin
seeing things that are not there
severe sunburn

Incidence not known

Backache
blindness
blue-yellow color blindness
bone pain
darkening of the skin
decreased vision
diarrhea
facial hair growth in females
fainting
fractures
full or round face, neck, or trunk
increased urination
irritability
loss of sexual desire or ability
menstrual irregularities
mental depression
muscle wasting
vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: