Voricare
Generic Name
Voriconazole 200 mg Tablet
Manufacturer
Acme Laboratories Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| voricare 200 mg tablet | ৳ 50.00 | ৳ 500.00 |
Description
Overview of the medicine
Voricare 200 mg tablet contains Voriconazole, an antifungal medication used to treat serious fungal infections caused by species such as Candida, Aspergillus, and Scedosporium.
Uses & Indications
Dosage
Adults
Initial loading dose: 400 mg every 12 hours for 2 doses. Maintenance dose: 200 mg every 12 hours. For patients weighing less than 40 kg, maintenance dose is 100 mg every 12 hours.
Elderly
No dose adjustment required, but caution is advised due to potential age-related decrease in hepatic function.
Renal_impairment
No dose adjustment needed for oral voriconazole. Accumulation of the intravenous excipient SBECD (sulfobutylether beta-cyclodextrin sodium) should be considered for IV formulations in severe renal impairment.
How to Take
Voricare tablets should be taken at least one hour before or one hour after a meal. Swallow the tablet whole with water. Do not crush or chew.
Mechanism of Action
Voriconazole is a triazole antifungal agent. It inhibits fungal cytochrome P450-mediated 14α-lanosterol demethylation, an essential step in fungal ergosterol biosynthesis. Ergosterol is a vital component of the fungal cell membrane, and its depletion leads to increased cell membrane permeability, leakage of cellular contents, and ultimately, fungal cell death.
Pharmacokinetics
Onset
Therapeutic levels typically achieved within 1-2 hours of oral administration.
Excretion
Primarily excreted in the urine as inactive metabolites (approximately 80%), with a small amount excreted in feces.
Half life
Dose-dependent, typically 6-24 hours. Non-linear kinetics at higher doses.
Absorption
Rapid and almost complete absorption after oral administration, with bioavailability of approximately 90%.
Metabolism
Extensively metabolized in the liver, primarily by cytochrome P450 isoenzymes CYP2C19, CYP2C9, and CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any component of the formulation
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to risk of QT prolongation and torsades de pointes)
- Co-administration with sirolimus (due to increased sirolimus concentrations)
- Co-administration with carbamazepine, rifampicin, rifabutin, long-acting barbiturates (due to significant reduction in voriconazole plasma concentrations)
- Co-administration with efavirenz (due to significant reduction in voriconazole plasma concentrations and risk of efavirenz toxicity)
- Co-administration with high-dose ritonavir (400 mg every 12 hours or more)
- Co-administration with ergot alkaloids (e.g., ergotamine, dihydroergotamine)
Drug Interactions
Warfarin
Increased prothrombin time; monitor INR and adjust warfarin dose.
Efavirenz
Significantly decreases voriconazole plasma concentrations and can cause efavirenz toxicity; co-administration is contraindicated.
Phenytoin
Increased phenytoin levels and decreased voriconazole levels; monitor phenytoin and adjust dose. Consider increasing voriconazole dose.
Omeprazole
Increased omeprazole concentrations and reduced voriconazole metabolism; monitor omeprazole and adjust dose. No dose adjustment for voriconazole needed.
Cyclosporine
Increased cyclosporine concentrations; monitor levels and adjust cyclosporine dose.
Carbamazepine
Significantly decreases voriconazole plasma concentrations; co-administration is contraindicated.
Rifampicin, Rifabutin
Significantly decreases voriconazole plasma concentrations; co-administration is contraindicated.
Statins (e.g., Atorvastatin)
Increased statin concentrations, leading to increased risk of myopathy/rhabdomyolysis; reduce statin dose and monitor.
Benzodiazepines (e.g., Midazolam)
Increased benzodiazepine concentrations; reduce benzodiazepine dose and monitor.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In cases of overdose, adverse events reported are consistent with those reported with therapeutic doses. There is no specific antidote for voriconazole. Management should be supportive, including gastric lavage if appropriate. Hemodialysis is not effective in removing voriconazole from the body.
Pregnancy & Lactation
Pregnancy Category D. Voriconazole can cause fetal harm when administered to a pregnant woman. Avoid during pregnancy unless the potential benefit outweighs the potential risk to the fetus. It is unknown if voriconazole is excreted in human milk; a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any component of the formulation
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to risk of QT prolongation and torsades de pointes)
- Co-administration with sirolimus (due to increased sirolimus concentrations)
- Co-administration with carbamazepine, rifampicin, rifabutin, long-acting barbiturates (due to significant reduction in voriconazole plasma concentrations)
- Co-administration with efavirenz (due to significant reduction in voriconazole plasma concentrations and risk of efavirenz toxicity)
- Co-administration with high-dose ritonavir (400 mg every 12 hours or more)
- Co-administration with ergot alkaloids (e.g., ergotamine, dihydroergotamine)
Drug Interactions
Warfarin
Increased prothrombin time; monitor INR and adjust warfarin dose.
Efavirenz
Significantly decreases voriconazole plasma concentrations and can cause efavirenz toxicity; co-administration is contraindicated.
Phenytoin
Increased phenytoin levels and decreased voriconazole levels; monitor phenytoin and adjust dose. Consider increasing voriconazole dose.
Omeprazole
Increased omeprazole concentrations and reduced voriconazole metabolism; monitor omeprazole and adjust dose. No dose adjustment for voriconazole needed.
Cyclosporine
Increased cyclosporine concentrations; monitor levels and adjust cyclosporine dose.
Carbamazepine
Significantly decreases voriconazole plasma concentrations; co-administration is contraindicated.
Rifampicin, Rifabutin
Significantly decreases voriconazole plasma concentrations; co-administration is contraindicated.
Statins (e.g., Atorvastatin)
Increased statin concentrations, leading to increased risk of myopathy/rhabdomyolysis; reduce statin dose and monitor.
Benzodiazepines (e.g., Midazolam)
Increased benzodiazepine concentrations; reduce benzodiazepine dose and monitor.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In cases of overdose, adverse events reported are consistent with those reported with therapeutic doses. There is no specific antidote for voriconazole. Management should be supportive, including gastric lavage if appropriate. Hemodialysis is not effective in removing voriconazole from the body.
Pregnancy & Lactation
Pregnancy Category D. Voriconazole can cause fetal harm when administered to a pregnant woman. Avoid during pregnancy unless the potential benefit outweighs the potential risk to the fetus. It is unknown if voriconazole is excreted in human milk; a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, depending on specific manufacturer and packaging.
Availability
Hospitals, pharmacies
Approval Status
Approved by FDA and DGDA
Patent Status
Generic versions available, original patent expired
WHO Essential Medicine
YesClinical Trials
Voriconazole has undergone extensive clinical trials demonstrating its efficacy and safety in various fungal infections, including large-scale trials for invasive aspergillosis, candidemia, and refractory fungal infections. Data from pivotal trials (e.g., a randomized, controlled trial comparing voriconazole with amphotericin B for invasive aspergillosis) support its use.
Lab Monitoring
- Liver function tests (ALT, AST, ALP, bilirubin) at baseline and during treatment
- Renal function tests (creatinine, BUN)
- Electrolytes
- Visual acuity and field assessments (especially during long-term therapy)
- Voriconazole plasma levels (therapeutic drug monitoring, especially in severe or refractory infections, or suspected toxicity/lack of efficacy)
Doctor Notes
- Monitor liver function tests carefully, especially in patients with pre-existing hepatic impairment.
- Be aware of numerous drug interactions, particularly with CYP3A4, CYP2C9, and CYP2C19 substrates/inhibitors/inducers.
- Educate patients on visual disturbances and photosensitivity, emphasizing avoidance of driving/machinery operation and sun protection.
- Consider therapeutic drug monitoring for optimal efficacy and to minimize toxicity, especially in critically ill, pediatric, or renally impaired patients (for IV formulation).
- Adjust dosage based on patient response and tolerability, especially for maintenance doses.
Patient Guidelines
- Take medicine as prescribed, at least one hour before or one hour after a meal.
- Report any changes in vision, skin rash, or signs of liver problems (e.g., dark urine, yellowing of skin/eyes) immediately.
- Avoid direct sunlight and use protective measures (sunscreen, protective clothing) due to photosensitivity.
- Do not drive or operate machinery if you experience visual disturbances.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Voricare can cause transient and reversible visual disturbances, including blurred vision, altered color perception, and photophobia. Patients should be warned not to drive or operate machinery if they experience these effects.
Lifestyle Advice
- Maintain good hygiene to prevent further infections.
- Avoid alcohol consumption during treatment as it can increase the risk of liver damage.
- Stay hydrated by drinking plenty of fluids.
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