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Voriconazole
Voriconazole is a broad-spectrum antifungal medication used to treat serious fungal infections, including invasive aspergillosis, candidemia, and other fungal infections in immunocompromised patients, such as those with HIV or those undergoing chemotherapy. It belongs to the class of triazole antifungals, which inhibit fungal growth by interfering with the synthesis of ergosterol, an essential component of fungal cell membranes.
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Frequently Asked Questions
How long does it take for voriconazole to work?
The response to voriconazole varies depending on the severity of the infection. Some patients may start to feel better within a few days, but treatment duration can last several weeks or even months, depending on the condition.
Can I drink alcohol while taking voriconazole?
It is best to avoid alcohol while taking voriconazole, as both voriconazole and alcohol can affect the liver, increasing the risk of liver damage.
What should I do if I miss a dose of voriconazole?
If you miss a dose, take it as soon as you remember, unless it’s close to your next scheduled dose. Do not take two doses at once to make up for a missed dose.
Is voriconazole safe during pregnancy?
Voriconazole is not recommended during pregnancy unless the potential benefits outweigh the risks. It may cause harm to the fetus, so effective contraception should be used during treatment.
Can voriconazole cause vision problems?
Yes, visual disturbances such as blurred vision, color changes, or light sensitivity are common with voriconazole. These effects are usually temporary and resolve within a few hours.
Comprehensive Drug Guide
How Does Voriconazole Work?
Voriconazole works by inhibiting fungal cytochrome P450-dependent enzyme 14α-sterol demethylase, which is critical for the synthesis of ergosterol, a key component of fungal cell membranes. Without ergosterol, the cell membrane becomes weakened, resulting in cell death and the inhibition of fungal growth. Voriconazole is effective against a wide range of fungi, including Aspergillus and Candida species.
Common Dosages
- Oral tablets (50 mg, 200 mg)
- Oral suspension
- Intravenous solution The typical adult oral or IV dose is based on weight, typically starting with a loading dose of 6 mg/kg every 12 hours, followed by a maintenance dose of 4 mg/kg every 12 hours.
Typical Dosing
- The usual dosing regimen for adults includes an initial loading dose followed by a maintenance dose:
- Loading dose: 6 mg/kg every 12 hours for 2 doses
- Maintenance dose: 4 mg/kg every 12 hours
- For pediatric patients, the dose is adjusted based on body weight and condition.
Typical Dosing
FDA Approved Indications
- Treatment of invasive aspergillosis
- Treatment of candidemia in non-neutropenic patients
- Treatment of other serious fungal infections such as Scedosporium and Fusarium species infections.
Who Shouldn't Take Voriconazole?
- Known hypersensitivity to voriconazole or other triazole antifungals
- Concurrent use of drugs that significantly interact with voriconazole (such as rifampin, carbamazepine, or long-acting barbiturates)
- Severe liver disease, unless under close medical supervision
Advice From The Pharmacist
- Take voriconazole either 1 hour before or 1 hour after meals, as food can affect its absorption.
- Avoid exposure to direct sunlight, as voriconazole can increase the risk of sunburn and skin damage. Wear protective clothing and sunscreen.
- If taking oral suspension, shake well before each use to ensure proper dosing.
- Regular blood tests may be required to monitor liver function and drug levels, especially during long-term use.
Side Effects of Voriconazole
Common Side Effects
- Visual disturbances (blurred vision, light sensitivity)
- Nausea or vomiting
- Headache
- Rash
- Elevated liver enzymes
Uncommon/Severe Side Effects
- Liver toxicity (jaundice, dark urine, upper abdominal pain)
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Heart rhythm abnormalities (QT prolongation)
- Stevens-Johnson syndrome (a rare but serious skin reaction)
Risks and Warnings of Voriconazole
- Liver Toxicity: Voriconazole can cause liver damage, particularly in patients with pre-existing liver conditions. Regular monitoring of liver function is recommended.
- Phototoxicity: Voriconazole increases sensitivity to sunlight, leading to an increased risk of severe sunburn and skin damage, including a higher risk of skin cancer with long-term use.
- Visual Disturbances: Temporary visual disturbances, such as blurred vision and increased sensitivity to light, are common but usually resolve within a few hours after taking a dose.
- QT Prolongation: Voriconazole may affect heart rhythm and prolong the QT interval, which can lead to serious arrhythmias, especially in patients with pre-existing heart conditions.
Interactions with Voriconazole
Common Drug Interactions
- Rifampin, carbamazepine, and barbiturates: These medications can significantly reduce voriconazole levels, making it less effective.
- Warfarin: Voriconazole can increase the effects of warfarin, leading to a higher risk of bleeding.
- Statins: Voriconazole can increase the blood levels of certain statins, increasing the risk of muscle damage (rhabdomyolysis).
- Oral contraceptives: Voriconazole may reduce the effectiveness of hormonal contraceptives, so additional non-hormonal contraception may be needed.
Alternatives to Voriconazole
- Itraconazole: Another triazole antifungal used for treating a variety of fungal infections.
- Posaconazole: A newer triazole antifungal that covers a broad spectrum of fungal pathogens.
- Amphotericin B: A broad-spectrum antifungal used for severe infections, though it carries a higher risk of kidney toxicity.
- Fluconazole: Another antifungal often used for less severe fungal infections, though it has a narrower spectrum of activity compared to voriconazole.
