Medicine Information

Vorifast

Name: Vorifast
Brand: Vorifast

Injection200 mgSystemic AntifungalsATC: J02AC03

Generic Name

Voriconazole

Manufacturer

Healthcare Pharmaceuticals Ltd.

Country

Bangladesh

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
vorifast 200 mg injection	৳ 2,000.00	N/A

Description

Overview of the medicine

Voriconazole is a triazole antifungal medication used to treat serious fungal infections, particularly invasive aspergillosis, candidemia in non-neutropenic patients, and other severe Candida infections.

Uses & Indications

Invasive aspergillosis

Candidemia in non-neutropenic patients

Serious invasive infections caused by Candida species resistant to fluconazole (including C. krusei and C. glabrata)

Serious invasive fungal infections caused by Scedosporium apiospermum and Fusarium species

Empirical therapy for febrile neutropenia (though less common than some other antifungals)

Dosage

Adults

Loading dose: 6 mg/kg IV every 12 hours for 2 doses. Maintenance dose: 4 mg/kg IV every 12 hours. For esophageal candidiasis, maintenance dose may be 3 mg/kg IV every 12 hours.

Elderly

No dose adjustment generally required based on age alone, but careful monitoring for adverse effects is recommended.

Renal_impairment

The intravenous formulation should be avoided in patients with moderate to severe renal impairment (creatinine clearance <50 mL/min) due to accumulation of the excipient SBECD (sulfobutylether beta-cyclodextrin sodium). Oral formulation should be considered.

How to Take

Administer by intravenous infusion over 1 to 2 hours. The infusion rate should not exceed 3 mg/kg per hour. Not for bolus injection. Reconstitute and dilute according to manufacturer's instructions.

Mechanism of Action

Voriconazole inhibits fungal cytochrome P450-dependent 14α-sterol demethylation, which is an essential step in fungal ergosterol biosynthesis. This leads to depletion of ergosterol and accumulation of 14α-methyl sterols, disrupting the fungal cell membrane and inhibiting fungal growth.

Pharmacokinetics

Onset

Rapidly achieves steady-state plasma concentrations within 24 hours with appropriate loading doses.

Excretion

Primarily eliminated via hepatic metabolism, with less than 2% excreted unchanged in urine. About 80% of metabolites are excreted in urine and 10% in feces.

Half life

Dose-dependent, with a terminal half-life typically ranging from 6 to 9 hours at therapeutic doses. However, due to non-linear kinetics, it can vary significantly.

Absorption

Administered intravenously, providing rapid and high systemic exposure.

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 component of the formulation.
Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine (due to risk of QT prolongation and torsade de pointes).
Co-administration with rifampicin, carbamazepine, phenobarbital, and efavirenz (due to significant decrease in voriconazole plasma concentrations).
Co-administration with high-dose ritonavir (≥400 mg every 12 hours), sirolimus, ergot alkaloids (ergotamine, dihydroergotamine), and St. John's wort (Hypericum perforatum).

Drug Interactions

Warfarin

May increase INR and risk of bleeding; close monitoring of prothrombin time/INR needed.

Phenytoin

Voriconazole may increase phenytoin levels, and phenytoin may decrease voriconazole levels; co-administration should be avoided unless benefits outweigh risks, with careful monitoring.

Rifampicin

Significantly decreases voriconazole plasma concentrations (contraindicated).

Cyclosporine

Voriconazole increases cyclosporine plasma concentrations; close monitoring of cyclosporine levels and dose adjustment needed.

Statins (e.g., Atorvastatin)

Increased risk of rhabdomyolysis and myopathy; dose reduction or temporary discontinuation of statins may be required.

Benzodiazepines (e.g., Midazolam)

Voriconazole may prolong the sedative effects; dose adjustment of benzodiazepines may be needed.

Storage

Store intact vials below 30°C (86°F). Protect from light. Do not freeze. Keep out of reach of children.

Overdose

In cases of overdose, patients should receive symptomatic and supportive care. Voriconazole is dialyzable, but the excipient SBECD (sulfobutylether beta-cyclodextrin sodium) in the intravenous formulation is not effectively removed by hemodialysis.

Pregnancy & Lactation

Pregnancy: Category D. Voriconazole may cause fetal harm when administered to a pregnant woman. It should not be used during pregnancy unless the benefits to the mother clearly outweigh the potential risks to the fetus. Lactation: It is unknown whether voriconazole is excreted in human milk. Due to potential serious adverse reactions in breastfed infants, breastfeeding is not recommended during treatment.

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 torsade de pointes).
Co-administration with rifampicin, carbamazepine, phenobarbital, and efavirenz (due to significant decrease in voriconazole plasma concentrations).
Co-administration with high-dose ritonavir (≥400 mg every 12 hours), sirolimus, ergot alkaloids (ergotamine, dihydroergotamine), and St. John's wort (Hypericum perforatum).

Drug Interactions

Warfarin

May increase INR and risk of bleeding; close monitoring of prothrombin time/INR needed.

Phenytoin

Voriconazole may increase phenytoin levels, and phenytoin may decrease voriconazole levels; co-administration should be avoided unless benefits outweigh risks, with careful monitoring.

Rifampicin

Significantly decreases voriconazole plasma concentrations (contraindicated).

Cyclosporine

Voriconazole increases cyclosporine plasma concentrations; close monitoring of cyclosporine levels and dose adjustment needed.

Statins (e.g., Atorvastatin)

Increased risk of rhabdomyolysis and myopathy; dose reduction or temporary discontinuation of statins may be required.

Benzodiazepines (e.g., Midazolam)

Voriconazole may prolong the sedative effects; dose adjustment of benzodiazepines may be needed.

Storage

Store intact vials below 30°C (86°F). Protect from light. Do not freeze. Keep out of reach of children.

Overdose

Pregnancy & Lactation

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

1 vial per pack

Shelf Life

Typically 2-3 years from manufacturing date, when stored properly. Reconstituted solution is stable for 24 hours at 2-8°C.

Availability

Hospitals, Pharmacies

Approval Status

FDA approved, widely approved

Patent Status

Generic available

Clinical Trials

Extensive clinical trials have demonstrated the efficacy and safety of voriconazole in treating various invasive fungal infections, including randomized controlled trials against conventional amphotericin B for invasive aspergillosis.

Lab Monitoring

Liver function tests (LFTs) at baseline and at least weekly during the first month of treatment, then monthly.
Renal function tests, including serum creatinine and BUN.
Electrolytes, particularly potassium and magnesium, to correct any abnormalities.
Therapeutic drug monitoring (TDM) of voriconazole plasma concentrations may be beneficial in certain populations (e.g., liver impairment, drug interactions, pediatric patients) to optimize efficacy and minimize toxicity.

Doctor Notes

Crucial to monitor liver function tests regularly, especially at treatment initiation and during the first month.
Consider therapeutic drug monitoring (TDM) to guide dosing in patients with liver impairment, significant drug interactions, or in pediatric populations to ensure adequate exposure and minimize toxicity.
Counsel patients on potential visual disturbances and photosensitivity, advising them to avoid direct sunlight and report changes promptly.
Be vigilant for drug interactions, particularly with CYP3A4, CYP2C9, and CYP2C19 substrates/inhibitors/inducers.
Avoid IV formulation in moderate to severe renal impairment due to SBECD accumulation; consider oral voriconazole if feasible.

Patient Guidelines

Report any new or worsening visual disturbances immediately to your healthcare provider.
Avoid direct exposure to sunlight and use protective measures (e.g., sunscreen, protective clothing) due to increased photosensitivity.
Do not discontinue treatment without consulting your doctor, even if you feel better.
Inform your doctor or pharmacist about all other medications, supplements, and herbal products you are taking.
Be aware of potential liver problems; report symptoms like unusual tiredness, nausea, vomiting, yellowing of skin/eyes, or dark urine.

Missed Dose Advice

If a dose is missed, administer it as soon as possible unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. Contact your doctor for advice.

Driving Precautions

Voriconazole can cause temporary and reversible visual disturbances, including blurred vision, altered color perception, and photophobia. Patients should avoid driving or operating machinery if they experience these effects.