Vori
Generic Name
Voriconazole
Manufacturer
Various (e.g., Pfizer, Square Pharmaceuticals)
Country
Global
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| vori 200 mg tablet | ৳ 100.00 | ৳ 1,000.00 |
Description
Overview of the medicine
Voriconazole is a broad-spectrum triazole antifungal medication used to treat various serious fungal infections, including invasive aspergillosis, esophageal candidiasis, and serious infections caused by Scedosporium apiospermum and Fusarium species.
Uses & Indications
Dosage
Adults
Loading dose: 400 mg every 12 hours for 2 doses; Maintenance dose: 200 mg every 12 hours. (Adjust based on weight and infection severity).
Elderly
No dose adjustment typically required, but monitor for adverse effects.
Renal_impairment
No dosage adjustment needed for oral voriconazole in mild to severe renal impairment. Avoid IV formulation in moderate to severe renal impairment due to cyclodextrin accumulation.
How to Take
Oral tablets should be taken at least one hour before or one hour after a meal. Swallow whole with water.
Mechanism of Action
Voriconazole inhibits fungal cytochrome P450-dependent 14-alpha-lanosterol demethylation, an essential step in fungal ergosterol biosynthesis. This inhibition leads to the accumulation of 14-alpha-methyl sterols and a decrease in ergosterol, disrupting fungal cell membrane function.
Pharmacokinetics
Onset
Peak plasma concentrations achieved in 1-2 hours.
Excretion
Primarily renal (80% as metabolites, <2% as unchanged drug). Less than 5% excreted in feces.
Half life
Approximately 6 hours (dose-dependent, non-linear kinetics).
Absorption
Well absorbed orally, with bioavailability of approximately 96%. Absorption is reduced by high-fat meals.
Metabolism
Primarily hepatic, via cytochrome P450 enzymes (CYP2C19, CYP2F9, CYP3A4). Extensive first-pass metabolism.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any excipients
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to QT prolongation)
- Co-administration with sirolimus, rifampin, carbamazepine, phenobarbital, ritonavir (high dose), efavirenz (high dose)
- Co-administration with ergot alkaloids
Drug Interactions
Warfarin
Increased anticoagulant effect, monitor INR. Voriconazole is a potent CYP2C9 inhibitor.
Phenytoin
Decreased voriconazole levels and increased phenytoin levels, monitor and adjust both doses. Voriconazole is a CYP2C9/2C19/3A4 inhibitor and phenytoin is an inducer.
Cyclosporine
Increased cyclosporine levels, monitor levels and adjust dose. Voriconazole inhibits cyclosporine metabolism.
Benzodiazepines
Increased benzodiazepine levels (e.g., midazolam) due to CYP3A4 inhibition.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, discontinue voriconazole and provide supportive care. Voriconazole is hemodialyzable. No specific antidote is available.
Pregnancy & Lactation
Pregnancy Category D. Should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Avoid breastfeeding as it is unknown if voriconazole is excreted in human milk.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any excipients
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to QT prolongation)
- Co-administration with sirolimus, rifampin, carbamazepine, phenobarbital, ritonavir (high dose), efavirenz (high dose)
- Co-administration with ergot alkaloids
Drug Interactions
Warfarin
Increased anticoagulant effect, monitor INR. Voriconazole is a potent CYP2C9 inhibitor.
Phenytoin
Decreased voriconazole levels and increased phenytoin levels, monitor and adjust both doses. Voriconazole is a CYP2C9/2C19/3A4 inhibitor and phenytoin is an inducer.
Cyclosporine
Increased cyclosporine levels, monitor levels and adjust dose. Voriconazole inhibits cyclosporine metabolism.
Benzodiazepines
Increased benzodiazepine levels (e.g., midazolam) due to CYP3A4 inhibition.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, discontinue voriconazole and provide supportive care. Voriconazole is hemodialyzable. No specific antidote is available.
Pregnancy & Lactation
Pregnancy Category D. Should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Avoid breastfeeding as it is unknown if voriconazole is excreted in human milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date, refer to product packaging for exact date.
Availability
Pharmacies, Hospitals
Approval Status
FDA Approved
Patent Status
Generic available
Clinical Trials
Extensively studied in numerous clinical trials demonstrating efficacy and safety for the treatment of invasive fungal infections in various patient populations.
Lab Monitoring
- Liver function tests (ALT, AST, alkaline phosphatase, bilirubin) at baseline and weekly during treatment
- Renal function (creatinine, BUN) at baseline and periodically
- Electrolytes (potassium, magnesium, calcium) at baseline and periodically
- Voriconazole plasma levels (therapeutic drug monitoring, especially in severe infections, toxicity, or specific patient populations)
- ECG (for QT interval) at baseline and periodically, especially with pre-existing cardiac conditions
Doctor Notes
- Monitor liver function tests, renal function, and electrolytes regularly, especially with prolonged use.
- Consider therapeutic drug monitoring (TDM) to optimize dosing and minimize toxicity, particularly in patients with CYP2C19 variants, hepatic impairment, or drug interactions.
- Counsel patients on potential visual disturbances, photosensitivity, and the importance of adherence to dosing instructions.
- Review all concomitant medications to identify potential drug interactions, especially with CYP450 substrates/inhibitors/inducers.
Patient Guidelines
- Take exactly as prescribed by your doctor, usually on an empty stomach.
- Do not stop taking the medicine without consulting your doctor, even if you feel better.
- Report any visual disturbances, rash, yellowing of skin/eyes, or severe abdominal pain immediately.
- Avoid direct sunlight and use protective measures (sunscreen, clothing) due to increased photosensitivity.
- Do not drive or operate machinery if you experience visual disturbances or dizziness.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. Do not double the dose.
Driving Precautions
May cause transient and reversible visual disturbances, including blurred vision, altered color perception, and/or photophobia. Patients should be advised not to drive or operate machinery if they experience these effects or dizziness.
Lifestyle Advice
- Maintain good hydration by drinking plenty of fluids.
- Avoid alcohol consumption while on treatment to prevent exacerbating liver issues.
- Protect skin from sun exposure (use sunscreen, protective clothing) due to photosensitivity.
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