Voricare
Generic Name
Voriconazole
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| voricare 50 mg tablet | ৳ 20.00 | ৳ 200.00 |
Description
Overview of the medicine
Voricare 50 mg Tablet contains Voriconazole, a broad-spectrum triazole antifungal agent used to treat serious fungal infections in immunocompromised patients, including invasive aspergillosis, candidemia, and esophageal candidiasis.
Uses & Indications
Dosage
Adults
The usual adult maintenance dose for oral administration is 200 mg (four 50 mg tablets) every 12 hours. A loading dose may be required initially, depending on the infection. Dosage adjustment may be needed for specific indications or patient conditions.
Elderly
No specific dose adjustment is usually required in elderly patients, but careful monitoring is advised due to potential age-related physiological changes.
Renal_impairment
No dose adjustment is needed for oral voriconazole in patients with renal impairment. For intravenous administration, caution is advised due to potential accumulation of the excipient SBECD, and oral route is preferred if possible.
Hepatic_impairment
For patients with mild to moderate hepatic impairment (Child-Pugh A or B), the maintenance dose should be halved. Voriconazole should be used with caution and careful monitoring in patients with severe hepatic impairment (Child-Pugh C).
How to Take
Take Voricare 50 mg Tablet at least one hour before or one hour after a meal. Swallow the tablet whole with water. Do not crush or chew. Complete the full course of treatment as prescribed by your doctor.
Mechanism of Action
Voriconazole inhibits fungal cytochrome P450-dependent 14α-lanosterol demethylation, an essential step in fungal ergosterol biosynthesis. This inhibition leads to the depletion of ergosterol and accumulation of 14α-methyl sterols, disrupting fungal cell membrane function and inhibiting growth.
Pharmacokinetics
Onset
Steady-state plasma concentrations are generally achieved within 24 hours with appropriate loading doses.
Excretion
Mainly through hepatic metabolism, with less than 2% of the unchanged drug excreted in urine. Metabolites are primarily eliminated via renal excretion.
Half life
Dose-dependent, variable (average terminal half-life approximately 6-8 hours, but can be longer with higher doses due to non-linear kinetics).
Absorption
Rapid and almost complete absorption after oral administration, with high bioavailability (approximately 90%). Absorption is reduced by food.
Metabolism
Primarily hepatic, mediated by CYP2C19, CYP2F9, and CYP3A4 enzymes. CYP2C19 is the major enzyme involved.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any excipients in the formulation.
- Co-administration with certain CYP3A4 substrates that prolong the QT interval (e.g., terfenadine, astemizole, cisapride, pimozide, quinidine).
- Co-administration with rifampin, carbamazepine, phenobarbital, ritonavir (high dose), efavirenz, sirolimus, ergot alkaloids (ergotamine, dihydroergotamine).
Drug Interactions
Warfarin
Voriconazole can increase warfarin's anticoagulant effect, requiring close INR monitoring and dose adjustment.
Omeprazole
Increases voriconazole Cmax and AUC. Voriconazole can also increase omeprazole Cmax and AUC. Dose adjustment for both may be needed.
Cyclosporine, Tacrolimus, Sirolimus
Voriconazole can significantly increase plasma concentrations of these immunosuppressants, requiring dose reduction and careful monitoring of levels.
Rifampin, Carbamazepine, Phenobarbital
Significantly decrease voriconazole plasma concentrations, leading to reduced efficacy. Concurrent use is contraindicated.
Storage
Store below 25°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, there is no known specific antidote for voriconazole. Management should be supportive and symptomatic. Hemodialysis is not effective in removing voriconazole from the body.
Pregnancy & Lactation
Pregnancy Category D. Voriconazole has shown teratogenic effects in animal studies; therefore, it should not be used during pregnancy unless the potential benefits outweigh the risks. Advise women of childbearing potential to use effective contraception. It is unknown whether voriconazole is excreted in human milk, thus caution is advised, and breastfeeding should be avoided during treatment.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any excipients in the formulation.
- Co-administration with certain CYP3A4 substrates that prolong the QT interval (e.g., terfenadine, astemizole, cisapride, pimozide, quinidine).
- Co-administration with rifampin, carbamazepine, phenobarbital, ritonavir (high dose), efavirenz, sirolimus, ergot alkaloids (ergotamine, dihydroergotamine).
Drug Interactions
Warfarin
Voriconazole can increase warfarin's anticoagulant effect, requiring close INR monitoring and dose adjustment.
Omeprazole
Increases voriconazole Cmax and AUC. Voriconazole can also increase omeprazole Cmax and AUC. Dose adjustment for both may be needed.
Cyclosporine, Tacrolimus, Sirolimus
Voriconazole can significantly increase plasma concentrations of these immunosuppressants, requiring dose reduction and careful monitoring of levels.
Rifampin, Carbamazepine, Phenobarbital
Significantly decrease voriconazole plasma concentrations, leading to reduced efficacy. Concurrent use is contraindicated.
Storage
Store below 25°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, there is no known specific antidote for voriconazole. Management should be supportive and symptomatic. Hemodialysis is not effective in removing voriconazole from the body.
Pregnancy & Lactation
Pregnancy Category D. Voriconazole has shown teratogenic effects in animal studies; therefore, it should not be used during pregnancy unless the potential benefits outweigh the risks. Advise women of childbearing potential to use effective contraception. It is unknown whether voriconazole is excreted in human milk, thus caution is advised, and breastfeeding should be avoided during treatment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months from the date of manufacture.
Availability
Available in pharmacies nationwide
Approval Status
FDA Approved
Patent Status
Patent expired / Generic available
Clinical Trials
Voriconazole has undergone extensive clinical trials demonstrating its efficacy and safety in treating various invasive fungal infections, including superiority over amphotericin B in invasive aspergillosis.
Lab Monitoring
- Liver function tests (ALT, AST, alkaline phosphatase, bilirubin) should be monitored at the initiation of therapy and at least weekly during treatment.
- Renal function tests (serum creatinine, BUN) and electrolytes should be monitored regularly.
- Therapeutic Drug Monitoring (TDM) of voriconazole plasma concentrations may be useful in certain patient populations (e.g., those with hepatic impairment, drug-drug interactions, or poor response to treatment).
Doctor Notes
- Careful dose adjustment and monitoring are required for patients with hepatic impairment. Consider dose reduction by half for mild to moderate impairment.
- Thorough review of concomitant medications is crucial due to the extensive potential for drug-drug interactions, particularly with CYP450 inhibitors/inducers.
- Therapeutic Drug Monitoring (TDM) should be considered for patients with altered pharmacokinetics, inadequate response, or suspected toxicity.
Patient Guidelines
- Take the medication exactly as prescribed by your doctor. Do not stop taking it without consulting your doctor, even if your symptoms improve.
- Report any changes in vision (blurred vision, altered color perception, sensitivity to light) to your doctor immediately.
- Avoid prolonged exposure to direct sunlight and use protective measures (e.g., sunscreen, protective clothing) as voriconazole can increase photosensitivity.
- If you experience any new or worsening side effects, particularly rash, jaundice, or severe abdominal pain, seek medical attention promptly.
Missed Dose Advice
If you miss a dose of Voricare, take it as soon as you remember, unless it is almost time for your next scheduled dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Voricare can cause transient and reversible visual disturbances (including blurred vision, altered color perception, or photophobia) and dizziness. Patients should avoid driving or operating machinery if they experience these side effects.
Lifestyle Advice
- Maintain good hydration and nutrition. Avoid alcohol consumption as it can increase the risk of liver toxicity.
- Inform your doctor about all other medications, herbal products, and supplements you are taking to avoid potential drug interactions.
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