Voriconazole is an azole antifungal medication indicated for use in patients aged 12 years and older for the treatment of the following fungal infections:

• Invasive aspergillosis
• Candidemia (in non-neutropenic patients) and disseminated candidiasis involving the skin, abdomen, kidneys, bladder wall, and wounds
• Esophageal candidiasis
• Serious infections caused by Scedosporium apiospermum and Fusarium species, including Fusarium solani
• Patients who are intolerant of or refractory to other antifungal therapies

Voriconazole is a triazole antifungal agent used in the treatment of severe fungal infections. It acts by binding to and inhibiting ergosterol synthesis through inhibition of the CYP450-dependent 14-alpha sterol demethylase enzyme. Inhibition of this enzyme results in depletion of ergosterol within the fungal cell membrane, thereby disrupting fungal cell membrane integrity.

Oral-
Voriconazole tablet and powder for suspension are to be taken at least one hour before or one hour following a meal

• At or over 40 kg body weight: Loading dose regimen is 400 mg or 10 ml every 12 hours (for the first 24 hours) and maintenance dose (after first 24 hours) is 200 mg or 5 ml twice daily.
• Below 40 Kg body weight: Loading dose regimen is 200 mg or 5 ml every 12 hours (for the first 24 hours) and maintenance dose (after first 24 hours) is 100 mg or 2.5 ml twice daily. Or, as directed by the registered physician.

Injection-
Invasive Aspergillosis :

• Loading dose: 6 mg/kg 12 hourly for the first 24 hours.
• Maintenance Dose: 4 mg/kg 12 hourly.

Candidemia in nonneutropenic patients and other deep tissue Candida infections:

• Loading dose: 6 mg/kg 12 hourly for the first 24 hours.
• Maintenance Dose: 3-4 mg/kg 12 hourly.

Scedosporiosis and Fusariosis:

• Loading dose: 6 mg/kg 12 hourly for the first 24 hours.
• Maintenance Dose: 4 mg/kg 12 hourly.

• CYP3A4, CYP2C9, and CYP2C19 inhibitors or inducers: Voriconazole dosage adjustment may be required, and patients should be monitored for adverse reactions or reduced therapeutic effectiveness.
• Voriconazole may increase the plasma concentration and activity of drugs that are substrates of CYP3A4, CYP2C9, and CYP2C19. Dose reduction of such medications may be necessary along with careful monitoring for adverse effects.
• Maintenance oral and intravenous doses of Voriconazole should be increased when administered concomitantly with Phenytoin or Efavirenz.

Voriconazole is contraindicated in patients with known hypersensitivity to Voriconazole or any component of this preparation.

• Concomitant administration with terfenadine, astemizole, cisapride, pimozide, quinidine, or sirolimus is contraindicated because of the risk of serious adverse reactions.
• Concomitant use with rifampin, carbamazepine, long-acting barbiturates, efavirenz, ritonavir, rifabutin, ergot alkaloids, and St. John’s Wort is contraindicated due to the risk of reduced efficacy.

The most commonly reported adverse effects include abdominal pain, anemia, blurred vision, headache, chest pain, nausea, and diarrhea.

There are no adequate and well-controlled studies of Voriconazole use in pregnant women. It should be used during pregnancy only when the potential therapeutic benefit justifies the possible risk to the fetus.

Long-term exposure to Voriconazole (treatment or prophylaxis exceeding 180 days) requires careful assessment of the benefit-risk balance. Cases of squamous cell carcinoma (SCC) of the skin have been reported in association with prolonged Voriconazole therapy.

The safety and efficacy of Voriconazole in children below 12 years of age have not been established.

There is limited information available regarding overdose with Voriconazole.

Other Antifungal preparations

Keep out of the reach of children. Store in a dry place below 25°C and protect from light. Voriconazole powder for suspension should be stored between 2°C and 8°C.