Vorifast
Generic Name
Voriconazole
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| vorifast 200 mg suspension | ৳ 1,000.00 | N/A |
Description
Overview of the medicine
Vorifast 200 mg Suspension contains Voriconazole, a broad-spectrum triazole antifungal agent, used to treat serious fungal infections. It works by inhibiting the growth of a wide range of fungi.
Uses & Indications
Dosage
Adults
Loading dose: 400 mg (10 mL) every 12 hours for 2 doses, then maintenance dose: 200 mg (5 mL) every 12 hours. Dosage may be adjusted based on weight and severity of infection.
Elderly
Similar to adult dosage, but monitor closely for adverse effects.
Renal_impairment
No dosage adjustment needed for oral administration. Monitor for accumulation of cyclodextrin vehicle in severe renal impairment (CrCl < 50 mL/min).
How to Take
Take the suspension at least one hour before or one hour after a meal. Shake well before use. Use the provided measuring device to ensure accurate dosing.
Mechanism of Action
Voriconazole inhibits fungal cytochrome P450-mediated 14α-lanosterol demethylation, an essential step in fungal ergosterol biosynthesis. This leads to the accumulation of 14α-methyl sterols and a decrease in ergosterol, thereby disrupting fungal cell membrane integrity and inhibiting fungal growth.
Pharmacokinetics
Onset
Within hours of administration for clinical effect.
Excretion
Mainly through hepatic metabolism, with less than 2% excreted unchanged in urine.
Half life
Dose-dependent, ranging from 6-12 hours in healthy volunteers, but can be much longer at higher doses due to non-linear kinetics.
Absorption
Rapid and almost complete absorption after oral administration, with peak plasma concentrations occurring 1-2 hours post-dose. Bioavailability is approximately 90%.
Metabolism
Extensively metabolized in the liver, primarily by CYP2C19, but also by 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 rifampicin, carbamazepine, phenobarbital, quinidine, sirolimus, ergot alkaloids (e.g., ergotamine, dihydroergotamine), St. John's wort, ritonavir (at high doses).
Drug Interactions
Warfarin
Increased prothrombin time/INR, monitor closely and adjust anticoagulant dose.
Ritonavir
Significant decrease in Voriconazole levels; co-administration contraindicated if ritonavir dose is high.
Rifampicin
Significant decrease in Voriconazole levels, co-administration contraindicated.
Carbamazepine/Phenobarbital
Significant decrease in Voriconazole levels, co-administration contraindicated.
Cyclosporine/Tacrolimus/Sirolimus
Increased levels of immunosuppressants, dose reduction and careful monitoring required.
Storage
Store the dry powder or unopened suspension at room temperature (20-25°C). Protect from moisture. After reconstitution, store the suspension at room temperature (20-25°C) or refrigerated (2-8°C) as per manufacturer's instructions. Do not freeze.
Overdose
In case of overdose, provide supportive care. Voriconazole is hemodialyzable, but the cyclodextrin vehicle is not. Monitor liver function and ECG.
Pregnancy & Lactation
Pregnancy Category D: Voriconazole can cause fetal harm when administered to a pregnant woman. Avoid use during pregnancy unless the potential benefit justifies the potential risk to the fetus. Lactation: It is unknown whether 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 rifampicin, carbamazepine, phenobarbital, quinidine, sirolimus, ergot alkaloids (e.g., ergotamine, dihydroergotamine), St. John's wort, ritonavir (at high doses).
Drug Interactions
Warfarin
Increased prothrombin time/INR, monitor closely and adjust anticoagulant dose.
Ritonavir
Significant decrease in Voriconazole levels; co-administration contraindicated if ritonavir dose is high.
Rifampicin
Significant decrease in Voriconazole levels, co-administration contraindicated.
Carbamazepine/Phenobarbital
Significant decrease in Voriconazole levels, co-administration contraindicated.
Cyclosporine/Tacrolimus/Sirolimus
Increased levels of immunosuppressants, dose reduction and careful monitoring required.
Storage
Store the dry powder or unopened suspension at room temperature (20-25°C). Protect from moisture. After reconstitution, store the suspension at room temperature (20-25°C) or refrigerated (2-8°C) as per manufacturer's instructions. Do not freeze.
Overdose
In case of overdose, provide supportive care. Voriconazole is hemodialyzable, but the cyclodextrin vehicle is not. Monitor liver function and ECG.
Pregnancy & Lactation
Pregnancy Category D: Voriconazole can cause fetal harm when administered to a pregnant woman. Avoid use during pregnancy unless the potential benefit justifies the potential risk to the fetus. Lactation: It is unknown whether 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 24 months for unopened bottles. Once reconstituted, specific duration (e.g., 14 days) when stored at room temperature or refrigerated.
Availability
Pharmacies, Hospitals
Approval Status
Approved (internationally and locally)
Patent Status
Off-patent (generic versions available)
WHO Essential Medicine
YesClinical Trials
Voriconazole has been extensively studied in numerous clinical trials demonstrating its efficacy and safety in treating a wide range of invasive fungal infections, including superiority over amphotericin B for invasive aspergillosis.
Lab Monitoring
- Liver function tests (ALT, AST, alkaline phosphatase, bilirubin) at baseline and during treatment.
- Renal function (creatinine, BUN) and electrolytes (potassium, magnesium) periodically.
- Serum voriconazole levels (therapeutic drug monitoring) may be useful in certain patients (e.g., severe liver impairment, non-responders, patients on interacting drugs).
Doctor Notes
- Emphasize the importance of adherence to the dosing schedule and proper administration (empty stomach).
- Educate patients about potential visual disturbances and photosensitivity. Advise caution with driving and sun exposure.
- Monitor LFTs, renal function, and electrolytes. Consider therapeutic drug monitoring in complex cases.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine abruptly, even if you feel better.
- Report any new or worsening side effects, especially visual changes or signs of liver problems (e.g., yellowing skin/eyes, dark urine).
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Voriconazole can cause visual disturbances (e.g., blurred vision, altered color perception, photophobia) and dizziness. Patients should avoid driving or operating machinery if they experience these effects.
Lifestyle Advice
- Avoid prolonged or unprotected exposure to sunlight or artificial UV light, as voriconazole can increase photosensitivity. Use sunscreen and wear protective clothing.
- Avoid alcohol consumption during treatment, as it may increase the risk of liver side effects.
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