Parenteral Manual

Voriconazole (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
VFEND
Classification: 
Antifungal
Original Date: 
November 2005
Revised Date: 
December 2019
Indications: 
  • Treatment of fungal infections (ex. aspergillosis, candida) in patients intolerant of, or refractory to conventional antifungal therapy
Reconstitution and Stability: 
  • Store vials at room temperature
  • Reconstitute each 200 mg vial with 19 mL of Sterile Water for Injection for a 10 mg/mL solution
  • Reconstituted vials stable 48 hours, refrigerated
  • Diluted solutions in D5W or NS, stable 24 hours refrigerated
Compatibility: 

- Solutions Compatible: D5W, 1/2 NS, NS, dextrose-saline combinations, ringer's lactate

- Additives/Above Cassette compatibility: KCL (up to 20 mmol/L)

- Y-site compatibility: TPN (amino acids/dextrose)

- Incompatible: blood products, sodium bicarbonate

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

Yes  Large Volume Pump ONLY.  Don't use a minibag smaller than 50 mL

Usual dilution: 0.5-5 mg/mL

Infusion time: 1-2 hours

Infusion rate: do not exceed 3 mg/kg/hour
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatrics, 2-11 yrs:

  • 7 mg/kg/dose IV Q12H

> 12 yrs and adult:

  • Loading dose: 6 mg/kg/dose IV every 12 hours x 2 doses
  • Maintenance dose:

-          Invasive aspergillosis or other serious fungal infections: 4 mg/kg/dose IV Q12H

-          Candidemia: 3 mg/kg/dose IV Q12H

Patients on concurrent phenytoin therapy:

  • increase maintenance dose to 5 mg/kg/dose IV Q12H

Dose adjustment in Renal Failure:

  • If CrCl < 50 mL/min, do not use IV voriconazole
  • accumulation of the IV vehicle SBECD occurs
  • use oral voriconazole instead
  • no dosage adjustment necessary for oral dosing                          
Potential hazards of parenteral administration: 
  • arrythmias, tachycardias, hypertension, hypotension, QT prolongation, torsades de pointes (rare)
  • headaches, dizziness, confusion
  • allergic reactions
  • hypokalemia, hypomagnesemia
  • nausea, vomiting, diarrhea
  • elevated liver enzymes
  • visual disturbances; photophobia, visual changes, colour vision changes
Notes: 
  • Monitor electrolytes, SCr, hepatic function and bilirubin
  • Contraindicated when co-administered with terfenadine, cisapride, pimozide or quinidine as increased plasma concentrations of these drugs can lead to QTc prolongation and rarely torsades de pointes
  • Inhibits the metabolism of many drugs, thus, many drug interactions. Contact pharmacy for details
  • Increases sirolimus levels
  • Increases warfarin levels; monitor INR
  • Increases cyclosporine levels; reduce cyclosporine dose to 1/2 of starting dose, monitor levels
  • Increases tacrolimus levels; reduce tacrolimus dose to 1/3 of starting dose, monitor levels

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