Voriconazole

The recommended adult starting dose of voriconazole is either 200 mg or 400 mg, taken 12 hours apart for the first 24 hours. After the first 24 hours, the recommended dose is 100 mg or 200 mg, taken twice daily. For both the starting dose and the maintenance dose, the dose used depends on your body weight and the type of infection. Your dose may be adjusted by your doctor depending on how you respond to voriconazole and the side effects you experience.

Voriconazole tablets should be taken 1 hour before or 2 hours after a meal.

Voriconazole oral suspension must be taken 1 hour before or after a meal.

If you are using the oral suspension, shake the closed bottle for approximately 10 seconds before each use. The suspension should only be administered using the oral dispenser supplied with each pack.

Voriconazole oral suspension should not be mixed with any other medication or flavouring agent and it should not be further diluted with water or any other drinks.

Injection: The dose for voriconazole intravenous (into the vein) injection depends on body weight and the type of infection. Your doctor will determine the right dose for you. The typical recommended starting dose of voriconazole injection during the first 24 hours is 2 doses of 6 mg for each kilogram of body weight, given 12 hours apart. After the first 24 hours, the recommended dose is 3 mg or 4 mg for each kilogram of body weight twice daily. Intravenous treatment with voriconazole should not exceed 6 months. The dose is usually injected slowly into a vein over 1 to 2 hours in a clinic setting (e.g., hospital). Your dose may be adjusted by your doctor depending on how you respond to voriconazole and the side effects you experience.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Your dose may be adjusted by your doctor depending on how you respond to voriconazole and the side effects you experience.

It is important to use Voriconazole exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule.

Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Voriconazole tablets and oral suspension, as well as the injectable forms of Voriconazole, should be stored at room temperature. Keep it out of reach of children. Safely discard any suspension that is left over after 14 days.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause spots or redness of the skin; it may cause a fever; it may cause nausea and vomiting; it may make your skin more sensitive to UV rays (e.g., sunlight, tanning lamps) - avoid exposure to UV rays as much as possible and protect yourself when out in the sun; it may cause vision problems. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Injection
Each single-use vial of white, sterile, lyophilized powder contains voriconazole 200 mg and sulphobutylether-ß-cyclodextrin sodium (SBECD) 3,200 mg. Preservative-free. Vials containing 200 mg lyophilized voriconazole are intended for reconstitution with water for injection to produce a solution containing 10 mg/mL voriconazole and 160 mg/mL of (SBECD) as a molecular inclusion complex.

Do not take voriconazole if you:

• are allergic to voriconazole or any ingredients of the medication (It is not known if people who are allergic to other "azole" antifungal medications [e.g., ketoconazole, fluconazole, and itraconazole] will also be allergic to voriconazole.)
• are also taking any of the following medications:
  • astemizole
  • Carbamazepine
  • cisapride
  • efavirenz
  • ergot alkaloids (ergotamine and Dihydroergotamine)
  • long-acting barbiturates (e.g., Phenobarbital)
  • Pimozide
  • quinidine
  • rifabutin
  • rifampin
  • ritonavir
  • Sirolimus
  • St. John's wort
  • terfenadine

There may be an interaction between voriconazole and any of the following:

• Abiraterone
• alpha blockers (e.g., Alfuzosin, Doxazosin, Silodosin, Tamsulosin)
• amantadine
• Amiodarone
• amphotericin B
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, Losartan)
• anti-cancer medications (e.g., Cabazitaxel, Docetaxel, Doxorubicin, Etoposide, Ifosfamide, Irinotecan, Vincristine)
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotic medications (e.g., chlorpromazine, Clozapine, Haloperidol, Quetiapine, Ziprasidone)
• Apomorphine
• Aprepitant
• Aripiprazole
• Apixaban
• other "azole" antifungals (e.g., ketoconazole, itraconazole)
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• benzodiazepines (e.g., Alprazolam, Chlordiazepoxide, Clonazepam, Clorazepate, Diazepam, Flurazepam, midazolam)
• birth control pills
• boceprevir
• Bosentan
• Brinzolamide
• Bromocriptine
• Buprenorphine
• Buspirone
• Calcitriol
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Felodipine,Verapamil)
• carbamazepine
• Celecoxib
• chloral hydrate
• chloramphenicol
• chloroquine
• cisapride
• Clopidogrel
• Colchicine
• conivaptan
• inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
• oral corticosteroids (e.g., Dexamethasone, Hydrocortisone, Prednisone)
• Cyclosporine
• Dantrolene
• Dapsone
• Diclofenac
• Disopyramide
• dofetilide
• Domperidone
• dronabinol
• dronedaraone
• Dutasteride
• Eplerenone
• ergot alkaloids (e.g., ergotamine and dihydroergotamine)
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• Ethosuximide
• Everolimus
• Famotidine
• felbamate
• fenofibric acid
• Fentanyl
• Fingolimod
• Flecainide
• Flutamide
• formoterol
• Galantamine
• Gemfibrozil
• "gliptin" diabetes medications (e.g., Linagliptin, Saxagliptin, Sitagliptin)
• grapefruit juice
• Guanfacine
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
• HIV nucleoside reverse transcriptase inhibitors (NRTIs; e.g., abacavir, didanosine, lamivudine, tenofovir, zidovudine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• Ibuprofen
• Indapamide
• isoniazid
• ketamine
• Leflunomide
• lidocaine
• lithium
• Lurasidone
• Macitentan

• macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin, telithromycin)
• Maprotiline
• maraviroc
• mefloquine
• mestranol
• Methadone
• Metronidazole
• mifepristone
• milk thistle
• Mirtazapine
• Modafinil
• Montelukast
• Nateglinide
• nefazodone
• nitrates (e.g., isosorbide dinitrate, isosorbide mononitrate)
• Octreotide
• opioid pain relievers (e.g., fentanyl, Morphine, methadone, Oxycodone)
• Paliperidone
• pentamidine
• Perampanel
• Phenytoin
• phosphodiesterase 5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pimecrolimus
• pimozide
• Prasugrel
• praziquantel
• Primaquine
• primidone
• progestins (e.g., Dienogest, Levonorgestrel, medroxyprogesterone, Norethindrone)
• procainamide
• Propafenone
• proton pump inhibitors (e.g., Omeprazole, Esomeprazole, Lansoprazole)
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• Repaglinide
• rifabutin
• rifampin
• rilpivirine
• Rivaroxaban
• Romidepsin
• St. John's wort
• salmeterol
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Duloxetine, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., alosetron, Granisetron, Ondansetron)
• sirolimus
• sitaxentan
• sotalol
• "statin" medications (e.g., Atorvastatin, Lovastatin, Simvastatin)
• Sucralfate
• sulfonamide antibiotics ("sulfas"; sulfadiazine, sulfamethoxazole, sulfisoxazole)
• sulfonylurea diabetes medications (e.g., chlorpropamide, Gliclazide, Glyburide, Tolbutamide)
• tacrolimus
• Tamoxifen
• telaprevir
• Temsirolimus
• Teniposide
• Tetrabenazine
• Tetracycline
• Theophylline
• Ticagrelor
• Ticlopidine
• tolbutamide
• Tolvaptan
• Tolterodine
• trabectedin
• Tramadol
• Trazodone
• tranylcipromine
• tricyclic antidepressants (e.g., Amitriptyline, desipramaine, Nortriptyline)
• Trimethoprim
• Ulipristal
• "triptan" migraine medications (e.g., Eletriptan, Sumatriptan)
• tyrosine kinase inhibitors (e.g., Dasatinib, imatinib, Nilotinib, Sunitinib)
• Venlafaxine
• Vorinostat
• Warfarin
• Zafirlukast
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Voriconazole. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Voriconazole.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., Sotalol, quinidine, thioridazine, Chlorpromazine, droperidol, pimozide, gatifloxacin, moxifloxacin, Mefloquine, pentamidine, arsenic trioxide, Dolasetron mesylate, probucol, Tacrolimus) can increase the risk of a type of abnormal heart rhythm called QT prolongation, and should not be used in combination with voriconazole. You are more at risk for this type of abnormal heart rhythm and its complications if you:

• are female
• are older than 65 years of age
• have a family history of sudden cardiac death
• have a history of heart disease or abnormal heart rhythms
• have a slow heart rate
• have congenital prolongation of the QT interval
• have Diabetes
• have had a Stroke
• have low potassium, magnesium, or calcium levels
• have nutritional deficiencies

If you have heart disease and abnormal heart rhythms, or are taking certain medications, discuss with your doctor how Voriconazole may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Voriconazole, and whether any special monitoring is needed.

Allergy: It is not clear whether people who have previously had an allergic reaction to another "azole" antifungal will have an allergic reaction to voriconazole. Make certain all medical professionals involved in your care know if you have had an allergic reaction to a different antifungal medication in this class, before taking voriconazole.

Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing, or swelling of the face and throat.

Infusion related problems: Reactions may occur during the infusion of the intravenous formulation of voriconazole. These include flushing, fever, sweating, rapid heart rate, chest tightness, difficulty breathing, feeling faint, nausea, itching, and rash. Report these to your doctor if they occur, as the infusion may have to be stopped.

Kidney problems: Rarely, voriconazole has been linked to developing kidney problems. If you have reduced kidney function or Kidney Disease, discuss with your doctor how Voriconazole may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Voriconazole, and whether any special monitoring is needed.

Signs of decreasing kidney function include the production of very small amounts of urine, swelling in your legs and feet, loss of appetite, nausea, vomiting, confusion and anxiousness, or excessive sleepiness. If you notice any of these, contact your doctor as soon as possible.

Lactose: Voriconazole tablets contain lactose. If you have or suspect you have galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption, voriconazole tablets may worsen your condition.

Liver function: Liver disease or reduced liver function may cause Voriconazole to build up in the body, causing side effects. As well, voriconazole may reduce liver function and can cause liver failure. Your doctor will monitor the function of your liver while you are taking Voriconazole. If you have liver problems, discuss with your doctor how Voriconazole may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Voriconazole, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Voriconazole.

Although serious liver reactions have been rare, contact your doctor if you notice signs of liver problems such as unusual fatigue, loss of appetite, nausea or vomiting, yellowing of the skin or eyes, dark urine, or pale stools. If you have severe liver cirrhosis, voriconazole should only be used if the benefits outweigh the risks, and you should be closely monitored by your doctor while you are taking the medication.

Pancreatitis (inflammation of the pancreas): Voriconazole may cause or worsen pancreatitis. If you have a history of or are at risk for developing pancreatitis (i.e., have had chemotherapy or a stem cell transplant), you should be closely monitored by your doctor while taking Voriconazole. If you develop signs of pancreatitis (e.g., upper left abdominal pain, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen), contact your doctor.

Skin reactions: In rare cases, people have had skin reactions when they have taken Voriconazole. If you get a skin rash that worsens, or if you experience exfoliating skin conditions such as peeling, shedding, or scaling of the skin, or any other unusual reaction of the skin, contact your doctor immediately. Your skin may also become sensitive to sunlight. Try to avoid strong sunlight while taking Voriconazole.

Vision changes: Voriconazole may cause blurry vision, reduced vision, colour vision change, and increased sensitivity of the eyes to sunlight. Most visual symptoms should clear up within 60 minutes. Avoid driving or operating machinery if you experience any changes in vision. Do not drive at night while taking voriconazole.

Pregnancy: Voriconazole can cause harm to the fetus when the medication is taken during pregnancy. Voriconazole should not be used during pregnancy. Women who may become pregnant should always use an effective form of birth control during treatment with voriconazole. If you become pregnant while taking Voriconazole, contact your doctor immediately.

Breast-feeding: It is not known if voriconazole passes into breast milk. If you are a breast-feeding mother and are taking Voriconazole, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Voriconazole have not been established for children less than 12 years of age.

This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Generally, a treatment with this medication lasts several days. Take it for the entire time prescribed in order to achieve the medication's full benefit. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. This medication should not be taken with food. It is best taken on an empty stomach, one hour before or 2 hours after a meal. Avoid consuming alcohol or alcohol-containing products while taking this medication.