Voriderm
Generic Name
Voriconazole
Manufacturer
XYZ Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| voriderm 50 mg tablet | ৳ 40.00 | ৳ 400.00 |
Description
Overview of the medicine
Voriderm 50 mg Tablet contains Voriconazole, a broad-spectrum triazole antifungal agent used to treat serious fungal infections. It works by stopping the growth of fungi. This medication is typically used for invasive aspergillosis, candidemia in non-neutropenic patients, and other severe Candida infections.
Uses & Indications
Dosage
Adults
Loading dose: 400 mg every 12 hours for 2 doses. Maintenance dose: 200 mg every 12 hours. For 50 mg, dosage adjustments will be specific to the condition and may require higher frequency or multiple tablets.
Elderly
No dosage adjustment is generally required based on age alone, but caution is advised due to potential for reduced hepatic and renal function.
Renal_impairment
No dosage adjustment is necessary for oral voriconazole in patients with mild to severe renal impairment. However, the accumulation of the intravenous vehicle (SBECD) can be an issue, not applicable to oral tablets.
How to Take
Voriderm tablets should be taken at least one hour before or one hour after a meal. Take with a glass of water. It is important to complete the full course of treatment as prescribed by your doctor.
Mechanism of Action
Voriconazole inhibits fungal cytochrome P450-dependent 14-alpha-sterol demethylation, which is an essential step in fungal ergosterol biosynthesis. This inhibition leads to the depletion of ergosterol and the accumulation of methylated sterol precursors, ultimately disrupting fungal cell membrane integrity and inhibiting fungal growth.
Pharmacokinetics
Onset
Within 1-2 hours for therapeutic levels.
Excretion
Less than 2% of the dose is excreted unchanged in urine. The majority is eliminated as metabolites through both renal and fecal routes.
Half life
Dose-dependent; approximately 6 hours at therapeutic doses, but can increase with higher doses due to non-linear kinetics.
Absorption
Rapid and almost complete absorption after oral administration, with peak plasma concentrations reached within 1-2 hours. Bioavailability is approximately 90%.
Metabolism
Extensively metabolized by hepatic cytochrome P450 enzymes, primarily CYP2C19, but also CYP2C9 and CYP3A4. Significant inter-individual variability due to CYP2C19 polymorphism.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any of its excipients
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to risk of QT prolongation and torsade de pointes)
- Co-administration with rifampicin, carbamazepine, phenobarbital, ritonavir (high dose), efavirenz, sirolimus, St. John's Wort (due to significant reduction in voriconazole levels)
Drug Interactions
Warfarin
Increases warfarin's anticoagulant effect. Monitor INR and adjust warfarin dose.
Phenytoin
Significantly decreases voriconazole levels and increases phenytoin levels. Monitor phenytoin levels and adjust voriconazole dose.
Omeprazole
Increases omeprazole exposure and voriconazole levels. Reduce omeprazole dose.
Cyclosporine, Tacrolimus, Sirolimus
Increases levels of these immunosuppressants. Reduce dose of immunosuppressant and monitor levels.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
In case of overdose, symptomatic and supportive treatment should be initiated. Voriconazole is hemodialyzed with a clearance of 12 mL/min; however, hemodialysis may not be sufficient to remove the drug from the body.
Pregnancy & Lactation
Voriconazole is classified as Pregnancy Category D, indicating evidence of fetal risk. It should not be used during pregnancy unless the benefit to the mother outweighs the potential risk to the fetus. It is unknown if voriconazole is excreted in human milk; therefore, breastfeeding is not recommended during treatment.
Side Effects
Contraindications
- Hypersensitivity to voriconazole or any of its excipients
- Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to risk of QT prolongation and torsade de pointes)
- Co-administration with rifampicin, carbamazepine, phenobarbital, ritonavir (high dose), efavirenz, sirolimus, St. John's Wort (due to significant reduction in voriconazole levels)
Drug Interactions
Warfarin
Increases warfarin's anticoagulant effect. Monitor INR and adjust warfarin dose.
Phenytoin
Significantly decreases voriconazole levels and increases phenytoin levels. Monitor phenytoin levels and adjust voriconazole dose.
Omeprazole
Increases omeprazole exposure and voriconazole levels. Reduce omeprazole dose.
Cyclosporine, Tacrolimus, Sirolimus
Increases levels of these immunosuppressants. Reduce dose of immunosuppressant and monitor levels.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
In case of overdose, symptomatic and supportive treatment should be initiated. Voriconazole is hemodialyzed with a clearance of 12 mL/min; however, hemodialysis may not be sufficient to remove the drug from the body.
Pregnancy & Lactation
Voriconazole is classified as Pregnancy Category D, indicating evidence of fetal risk. It should not be used during pregnancy unless the benefit to the mother outweighs the potential risk to the fetus. It is unknown if voriconazole is excreted in human milk; therefore, breastfeeding is not recommended 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 and hospitals
Approval Status
Approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Voriconazole has been extensively studied in numerous clinical trials demonstrating its efficacy and safety for treating various invasive fungal infections. These trials have supported its approval for broad use in immunocompromised and other high-risk patient populations.
Lab Monitoring
- Liver function tests (ALT, AST, alkaline phosphatase, bilirubin) at baseline and at least weekly during treatment.
- Renal function tests (serum creatinine, BUN) periodically.
- Electrolyte levels (especially potassium, magnesium, calcium) as disturbances can affect cardiac rhythm.
- Voriconazole plasma levels (therapeutic drug monitoring) in certain patients, especially those with suspected toxicity or treatment failure.
Doctor Notes
- Monitor liver function tests (LFTs) closely, especially at the start of therapy and if signs of hepatotoxicity appear.
- Be vigilant for visual disturbances; advise patients to report changes and avoid driving.
- Extensive drug-drug interactions, particularly with CYP450 substrates/inhibitors/inducers. Review all concomitant medications.
- Consider therapeutic drug monitoring (TDM) in patients with poor response, suspected toxicity, or altered pharmacokinetics (e.g., severe renal/hepatic impairment).
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor, do not stop without consultation.
- Take the tablets on an empty stomach, at least one hour before or after meals.
- Be aware of potential visual disturbances and avoid activities requiring clear vision if affected.
- Avoid direct sun exposure and use protective measures (sunscreen, protective clothing) due to increased photosensitivity.
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 take a double dose to make up for a missed one.
Driving Precautions
Voriconazole can cause temporary 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 any visual changes or dizziness during treatment.
Lifestyle Advice
- Avoid alcohol consumption as it may increase the risk of liver side effects.
- Maintain good hydration.
- Discuss all other medications, including over-the-counter drugs and herbal supplements, with your doctor to avoid interactions.
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