Voriderm
Generic Name
Voriconazole
Manufacturer
Example Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
Variant | Unit Price | Strip Price |
---|---|---|
voriderm 200 mg suspension | ৳ 1,000.00 | N/A |
Description
Overview of the medicine
Voriconazole is a broad-spectrum triazole antifungal agent used to treat serious fungal infections, including invasive aspergillosis, candidemia, and other severe fungal infections.
Uses & Indications
Dosage
Adults
Loading dose: 400 mg every 12 hours for 2 doses; Maintenance dose: 200 mg every 12 hours.
Elderly
No dose adjustment generally required, but monitor for toxicity and adjust based on tolerability.
Renal_impairment
No oral dose adjustment needed. Avoid IV voriconazole if creatinine clearance < 50 mL/min due to accumulation of the sulfobutyl ether beta-cyclodextrin vehicle.
How to Take
Oral suspension should be taken at least one hour before or one hour after a meal. Shake the bottle well for approximately 10 seconds before each use. Administer using an oral dosing syringe.
Mechanism of Action
Voriconazole inhibits fungal cytochrome P450-dependent 14-alpha-lanosterol demethylation, blocking the synthesis of ergosterol, an essential component of the fungal cell membrane.
Pharmacokinetics
Onset
Therapeutic plasma concentrations typically achieved within 1-2 hours after oral administration.
Excretion
Mainly eliminated via metabolism (less than 2% of the dose excreted unchanged in urine).
Half life
Dose-dependent, approximately 6 hours at therapeutic doses. Exhibits non-linear kinetics.
Absorption
Rapid and extensive oral absorption with a bioavailability of about 96%. Absorption is decreased with high-fat meals.
Metabolism
Primarily hepatic, via cytochrome P450 enzymes (CYP2C19, CYP2C9, CYP3A4). CYP2C19 is a major metabolizing enzyme.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any excipients
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine, sirolimus, rifampicin, carbamazepine, long-acting barbiturates, efavirenz, high-dose ritonavir, or St. John's wort.
Drug Interactions
Warfarin
May increase INR; monitor closely.
Phenytoin
May significantly decrease voriconazole levels and increase phenytoin levels; monitor both.
Cyclosporine, Tacrolimus, Sirolimus
Voriconazole increases levels of these immunosuppressants; reduce immunosuppressant dose and monitor.
Rifampicin, Carbamazepine, Phenobarbital
Significant decrease in voriconazole plasma concentrations (contraindicated).
Storage
Store the powder below 30°C. Do not refrigerate or freeze the powder. Store the reconstituted suspension refrigerated (2°C to 8°C) and do not freeze. Discard any unused suspension after 14 days.
Overdose
In case of overdose, symptomatic and supportive care should be instituted. Voriconazole is not effectively removed by hemodialysis. Monitor for signs of hepatotoxicity and neurotoxicity.
Pregnancy & Lactation
Pregnancy Category D. Voriconazole should be avoided during pregnancy unless the potential benefit to the mother outweighs the potential risk to the fetus. It is not recommended during lactation as it is unknown if it is excreted in human milk.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any excipients
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine, sirolimus, rifampicin, carbamazepine, long-acting barbiturates, efavirenz, high-dose ritonavir, or St. John's wort.
Drug Interactions
Warfarin
May increase INR; monitor closely.
Phenytoin
May significantly decrease voriconazole levels and increase phenytoin levels; monitor both.
Cyclosporine, Tacrolimus, Sirolimus
Voriconazole increases levels of these immunosuppressants; reduce immunosuppressant dose and monitor.
Rifampicin, Carbamazepine, Phenobarbital
Significant decrease in voriconazole plasma concentrations (contraindicated).
Storage
Store the powder below 30°C. Do not refrigerate or freeze the powder. Store the reconstituted suspension refrigerated (2°C to 8°C) and do not freeze. Discard any unused suspension after 14 days.
Overdose
In case of overdose, symptomatic and supportive care should be instituted. Voriconazole is not effectively removed by hemodialysis. Monitor for signs of hepatotoxicity and neurotoxicity.
Pregnancy & Lactation
Pregnancy Category D. Voriconazole should be avoided during pregnancy unless the potential benefit to the mother outweighs the potential risk to the fetus. It is not recommended during lactation as it is unknown if it is excreted in human milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Powder for suspension: Typically 24-36 months. Reconstituted suspension: 14 days when stored refrigerated (2-8°C).
Availability
Pharmacies, Hospitals
Approval Status
Approved by regulatory authorities (e.g., FDA, DGDA)
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Voriconazole has undergone extensive clinical trials demonstrating its efficacy and safety in treating a wide range of invasive fungal infections, including randomized controlled trials against other antifungal agents.
Lab Monitoring
- Liver function tests (ALT, AST, alkaline phosphatase, bilirubin) at baseline and during treatment
- Renal function (creatinine, BUN)
- Serum voriconazole levels (therapeutic drug monitoring) to optimize efficacy and minimize toxicity
- Electrolytes (especially potassium and magnesium)
Doctor Notes
- Therapeutic drug monitoring (TDM) of voriconazole is highly recommended, especially in patients with severe infections, liver impairment, or those on co-medications that interact with CYP450 enzymes, to ensure optimal efficacy and minimize toxicity.
- Educate patients on potential visual disturbances and photosensitivity. Advise them to avoid driving or operating machinery if visual changes occur, and to use sun protection.
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor, do not stop without consultation.
- Always shake the oral suspension well before each use.
- Report any new or worsening symptoms, especially visual changes, skin rash, or signs of liver problems, to your doctor immediately.
- Avoid direct sunlight and use protective clothing and sunscreen due to increased risk of phototoxicity.
Missed Dose Advice
If a dose is missed, take it as soon as you remember unless it is almost time for your next scheduled dose. Do not take a double dose to make up for a missed one.
Driving Precautions
Voriconazole may cause temporary and reversible visual disturbances (e.g., blurred vision, altered light perception, photosensitivity). Patients should be cautioned against driving or operating machinery at night or in hazardous situations if they experience these effects.
Lifestyle Advice
- Maintain a healthy diet and stay hydrated, but avoid high-fat meals around dosing.
- Limit or avoid alcohol consumption as it can increase the risk of liver damage.
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