Normal avoid iv preparation if possible and only use iv if the patient is unable to. It belongs to a class of drugs known as azole antifungals. 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. Treatment should be initiated with intravenous regimen, and oral regimen should be considered only after there is a significant clinical improvement. The most current version of the renal dosage adjustment guidelines for antimicrobials and associated. A 4hour hemodialysis session does not remove a sufficient amount of voriconazole to warrant dose adjustment. Safety and tolerability of voriconazole in patients with baseline. The intravenous vehicle, sbecd, is hemodialyzed with clearance of 55 mlmin. Iv formulation does not contain cyclodextrin and requires no dose adjustment for renal impairment 1.
Click here for a specialized list of other renal medication dosing not listed in the alphabetical main section simple renal dosing guidelines. 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. It can be taken by mouth or used by injection into a vein. Voriconazole is a triazole antifungal agent used primarily in the treatment or prevention of aspergillosis and candidal infections. Crrt is off, dose as hemodialysis patients or based on any residual renal function. Phase i clinical trial for comparison of pharmacokinetic. In patients with moderate or severe renal impairment creatinine clearance intravenous infusion of vfend, accumulation of the intravenous vehicle, sbecd, occurs. Serum concentrations and tolerability of standard and weightbased oral dosing regimens of. The recommendations below should be used as a guideto aid in antibiotic dosing while on crrt.
The renal drug handbook the st georges hospital, adult critical. Similar worsening renal function for intravenous voriconazole ivv and oral voriconazole. Monitoring of voriconazole levels at university hospital. Read the patient information leaflet if available from your pharmacist before you start using voriconazole and each time you get a refill.
Voriconazole is used to treat a variety of fungal infections. Voriconazole therapy is associated with transient, asymptomatic serum aminotransferase elevations and is a known cause of clinically apparent acute drug induced liver injury. 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. Voriconazole may also be used for purposes not listed in this medication.
Vfend voriconazole dosage and administration pfizer. This third edition of the renal drug handbook is a fantastic publication. Voriconazole definition of voriconazole by medical. The authors make no claims of the accuracy of the information contained herein. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Antifungal dosing in dialysis and continuous renal. Intravenous voriconazole formulated with sbecd was effective in patients with moderate or severe renal insufficiency and candidemia and was associated with. Several case reports and retrospective cohort studies recommended the use of adjusted body weight for voriconazole dosing in obese patients. 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. Renal impairment intravenous vehicle may accumulate if egfr less than 50 mlminute1.
Following oral dosing, voriconazole absorption is rapid and nearly complete, with a relative bioavailability approaching 90%. 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 is eliminated via hepatic metabolism with less than 2% of the dose excreted unchanged in the urine. 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. Dosing regimens should be tailored based on presumed source of infection, mic data when available, and residual renal function. Comprehensive update to antimicrobial renal dosing document.
Voriconazole is hemodialyzed with clearance of 121 mlmin. Dailymed voriconazole injection, powder, for solution. 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. Get emergency medical help if you have signs of an allergic reaction hives, difficult breathing, swelling in your face or throat or a severe skin reaction fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling. Invasive aspergillosis and serious fungal infections due to fusarium species and scedosporium apiospermum. 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 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. In 17 adolescent patients for whom mean plasma concentrations were calculated. In a multiple dose study of iv voriconazole 6 mgkg iv loading dose x 2, then 3 mgkg iv x 5. Voriconazole fda prescribing information, side effects.
Warfarin 30 mg single dose, co administered with 300 mg bid voriconazole cyp2c9 substrate. 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. Voriconazole intravenous route precautions mayo clinic. Penicillamine, penicillin g, penicillin vk, pentamidine iv, pentazocine. Cresemba can be administered through a peripheral or central venous line 4. Voriconazole medicinal forms bnf content published by nice.
Voriconazole, sold under the brand name vfend among others, is an antifungal medication used to treat a number of fungal infections. 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. Evaluation of intravenous voriconazole in patients with. What are the possible side effects of voriconazole vfend. Moderate or severe renal dysfunction crcl less than 50 mlmin.
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. Antimicrobial dosing in renal insufficiency adults. Oral voriconazole should be used unless the benefit to risk ratio justifies iv use. Iv formulation must be administered via an infusion set with an inline filter pore size 0. 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. Consider an oral regimen only after there is a significant clinical improvement.
Worsening renal function in patients with baseline renal impairment. Voriconazole side effects, dosage, interactions drugs. 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. The oral dose recommendation for children is based on studies in which vfend was administered as the powder for oral suspension formulation. In patients with moderate or severe renal insufficiency creatinine clearance 2. Appropriate dosing of antifungal drugs is crucial to achieving favorable outcomes in patients with invasive fungal infections. Administration of intravenous voriconazole to patients with creatinine. Pharmacokinetics of voriconazole after intravenous and. Voriconazole is moderately bound to plasma proteins and is widely distributed throughout the body. Keep taking this medicine until the course is finished, unless you are told to stop. Accumulation of the iv vehicle, sbecd sulfobutyl ether. Decrease po maintenance dose by 50% renal impairment crcl.
Renal dose adjustment guidelines for antimicrobials crrt. 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. Vfend voriconazole dosing, indications, interactions. Verapamil, vigabatrin, vinblastine, vincristine, vinorelbine, voriconazole, warfarin. Voriconazole may increase your or your childs risk of having kidney problems, including acute kidney failure.
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