The authors make no claims of the accuracy of the information contained herein. Voriconazole, sold under the brand name vfend among others, is an antifungal medication used to treat a number of fungal infections. The recommendations below should be used as a guideto aid in antibiotic dosing while on crrt. Ciprofloxacin 1,2, iv po 5, 6, 8 50 crcl 50 crcl 30 50 crcl iv q12h 500 mg po q12h same 400 mg iv q24h 500 mg po q24h pseudomonas, severe 400 mg iv q8h 750 mg po q12h 400 mg iv q812h 500 mg po q12h 400 mg iv q24h 500 mg po q24h 400 mg iv q24h 0 mg po q24h give post hd on hd days 400 mg iv q1224h. It belongs to a class of drugs known as azole antifungals. In 17 adolescent patients for whom mean plasma concentrations were calculated. Ibwideal body weight use tbw if ibw is greater than patients weight abwadjusted body weight tbwtotal body weight.
Voriconazole is hemodialyzed with clearance of 121 mlmin. The most current version of the renal dosage adjustment guidelines for antimicrobials and associated. Voriconazole therapy is associated with transient, asymptomatic serum aminotransferase elevations and is a known cause of clinically apparent acute drug induced liver injury. Oral voriconazole should be used unless the benefit to risk ratio justifies iv use. Voriconazole may increase your or your childs risk of having kidney problems, including acute kidney failure. The intravenous vehicle, sbecd, is hemodialyzed with clearance of 55 mlmin. Antifungal dosing in dialysis and continuous renal. Worsening renal function in patients with baseline renal impairment. In 11 adolescent patients who received a mean voriconazole maintenance dose of 4 mgkg iv, the median of the calculated mean plasma concentrations was 1. Administration of voriconazole in patients with renal dysfunction.
Read the patient information leaflet if available from your pharmacist before you start using voriconazole and each time you get a refill. Phase i clinical trial for comparison of pharmacokinetic. 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. Comprehensive update to antimicrobial renal dosing document. Voriconazole is eliminated via hepatic metabolism with less than 2% of the dose excreted unchanged in the urine. Voriconazole intravenous route precautions mayo clinic.
Voriconazole is a triazole antifungal agent used primarily in the treatment or prevention of aspergillosis and candidal infections. Evaluation of intravenous voriconazole in patients with. Voriconazole is moderately bound to plasma proteins and is widely distributed throughout the body. A 4hour hemodialysis session does not remove a sufficient amount of voriconazole to warrant dose adjustment. Antifungal pregnancy risk category d action inhibits fungal cytochrome p450mediated 14alphalanosterol demethylation, preventing fungal biosynthesis and inactivating fungal cell availability lyophilized powder for injection. Abacavir abacavir lamivudine abacavir lamivudine zidovudine acarbose acebutolol acetaminophen acetazolamide acetohexamide acetohydroxamic acid acetylsalicylic acid aspirin acrivastine acyclovir adefovir adenosine albuterol inhaled albuterol oral alfentanil alfentanil allopurinol alprazolam alteplase tissuetype plasminogen activator. In patients with moderate or severe renal impairment creatinine clearance intravenous infusion of vfend, accumulation of the intravenous vehicle, sbecd, occurs. What are the possible side effects of voriconazole vfend. Dailymed voriconazole injection, powder, for solution. Mortality was higher in the voriconazole group compared with the other two groups, likely as a result of the severity of the underlying fungal disease. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry.
Vfend voriconazole dosage and administration pfizer. Similarly, the number of patients with compromised renal function treated with intravenous voriconazole is low and likely related to labeling that raises concerns about renal toxicity in this group. Among 166 patients in whom baseline renal function was assessed, 42 25. Safety and tolerability of voriconazole in patients with baseline. Cresemba can be administered through a peripheral or central venous line 4.
Administration of intravenous voriconazole to patients with creatinine. Administration of voriconazole in patients with renal. Pharmacokinetics of voriconazole after intravenous and. Renal impairment intravenous vehicle may accumulate if egfr less than 50 mlminute1. After administration of a single radiolabelled dose of either oral or iv voriconazole, preceded by multiple oral or iv dosing, approximately 80% to 83% of the. The use of various types of renal replacement therapy rrt in patients with severe acute or chronic renal insufficiency adds another level of complexity to the already challenging use of these drugs. Invasive aspergillosis and serious fungal infections due to fusarium species and scedosporium apiospermum. Normal avoid iv preparation if possible and only use iv if the patient is unable to. Monitoring of voriconazole levels at university hospital. Continuous hemodialysis assumes an ultrafiltration rate of 2lh and dialysate flow rate of 1lh with cvvhdf and residual native gfr of iv q6hr, or 4. Voriconazole side effects, dosage, interactions drugs. Iv formulation does not contain cyclodextrin and requires no dose adjustment for renal impairment 1. After administration of a single radiolabelled dose of either oral or iv voriconazole, preceded by multiple oral or iv dosing, approximately 80% to 83% of the radioactivity is recovered in the urine. The oral dose recommendation for children is based on studies in which vfend was administered as the powder for oral suspension formulation.
Oral voriconazole should be administered to these patients, unless an assessment of the benefitrisk to the patient justifies the use of intravenous vfend. Accumulation of the iv vehicle, sbecd sulfobutyl ether. Verapamil, vigabatrin, vinblastine, vincristine, vinorelbine, voriconazole, warfarin. Consider an oral regimen only after there is a significant clinical improvement.
Prepared by the fraser health antimicrobial stewardship program. In a multiple dose study of iv voriconazole 6 mgkg iv loading dose x 2, then 3 mgkg iv x 5. Appropriate dosing of antifungal drugs is crucial to achieving favorable outcomes in patients with invasive fungal infections. Several case reports and retrospective cohort studies recommended the use of adjusted body weight for voriconazole dosing in obese patients. Treatment should be initiated with intravenous regimen, and oral regimen should be considered only after there is a significant clinical improvement. This third edition of the renal drug handbook is a fantastic publication. Dosing regimens should be tailored based on presumed source of infection, mic data when available, and residual renal function. The renal drug handbook the st georges hospital, adult critical.
Keep taking this medicine until the course is finished, unless you are told to stop. Antimicrobial dosing in renal insufficiency adults. Vfend voriconazole dosing, indications, interactions. Intravenous voriconazole formulated with sbecd was effective in patients with moderate or severe renal insufficiency and candidemia and was associated with. Crrt is off, dose as hemodialysis patients or based on any residual renal function. Renal dose adjustment guidelines for antimicrobials crrt. No rationale for pov over ivv in preexisting renal impairment. Note that an 8 mgkg intravenous dose will provide voriconazole exposure approximately 2fold higher than a 9 mgkg oral dose. Intravenous iv voriconazole is not recommended in patients with creatinine clearance iv formulation of voriconazole has resulted in the recommendation that this formulation be used with caution in patients with creatinine clearances cl cr iv voriconazole compared with two other iv antifungals not containing sbecd in patients with compromised renal function. In patients with moderate or severe renal insufficiency creatinine clearance 2. Penicillamine, penicillin g, penicillin vk, pentamidine iv, pentazocine. Serum concentrations and tolerability of standard and weightbased oral dosing regimens of. Voriconazole is used to treat infections caused by yeast or other types of fungus.
Phenytoin may be coadministered with voriconazole if the maintenance dose of voriconazole is increased to 5 mgkg iv bid or from 200 mg to 400 mg oral bid 100 mg to 200 mg oral bid in patients less than 40 kg see section 4. Following oral dosing, voriconazole absorption is rapid and nearly complete, with a relative bioavailability approaching 90%. Voriconazole fda prescribing information, side effects. Decrease po maintenance dose by 50% renal impairment crcl. Warfarin 30 mg single dose, co administered with 300 mg bid voriconazole cyp2c9 substrate. Similar worsening renal function for intravenous voriconazole ivv and oral voriconazole. Objective to determine pharmacokinetics and adverse effects after voriconazole administration to cats and identify an oral dose of voriconazole for cats that maintains plasma drug concentrations within a safe and effective range animals 6 healthy cats procedures voriconazole 1 mgkg, iv was administered to each cat phase 1. Click here for a specialized list of other renal medication dosing not listed in the alphabetical main section simple renal dosing guidelines. Several studies demonstrated that the use of intravenous vrc in patients with baseline moderate to severe renal impairment did not lead to acute renal toxicity 3. Moderate or severe renal dysfunction crcl less than 50 mlmin. It can be taken by mouth or used by injection into a vein. Iv formulation must be administered via an infusion set with an inline filter pore size 0. Antimicrobial dosing in renal insufficiency fraser health medical. Effect of cumulative intravenous voriconazole dose on renal.
This includes aspergillosis, candidiasis, coccidioidomycosis, histoplasmosis, penicilliosis, and infections by scedosporium or fusarium. Voriconazole is used to treat a variety of fungal infections. Voriconazole medicinal forms bnf content published by nice. Voriconazole definition of voriconazole by medical. Voriconazole may also be used for purposes not listed in this medication.