Section 15 · Monograph
Voriconazole
Reviewed Nov 2026FDA label
VfendTriazole antifungal
- Forms
- Tab: 50, 200mg | IV: 200mg | Susp: 40mg/mL
- Dose
- CNS aspergillosis: 6mg/kg IV every 12h x2 doses, then 4mg/kg every 12h (or 200mg PO every 12h); guided by drug levels
- MOA
- Inhibits fungal CYP51; excellent CNS penetration
Indications
- Invasive aspergillosis; candidemia; esophageal candidiasis; Scedosporium and Fusarium infectionsFDA-labeled
Off-Label Uses
- CNS aspergillosis (first-line)Off-label
Mechanism of Action
- Triazole that inhibits fungal CYP51; fungicidal against Aspergillus with excellent CNS penetration
Full Dosing
Adult / usual
- Invasive aspergillosis/CNS aspergillosis: 6mg/kg IV every 12 hours for 2 doses, then 4mg/kg IV every 12 hours (or 200mg PO every 12 hours; 300mg if needed); for oral, take 1 hour before or after meals
- Therapeutic drug monitoring recommended: target trough about 1-5.5mcg/mL
Renal
- IV formulation requires renal caution (SBECD vehicle) when CrCl below 50mL/min
Contraindications
- Hypersensitivity to voriconazole
- Coadministration with sirolimus, rifampin, rifabutin, carbamazepine, long-acting barbiturates (phenobarbital), ritonavir (high dose), efavirenz (standard dose), St. John's wort, ergot alkaloids, pimozide, quinidine and other CYP substrates with serious toxicity
Drug Interactions
- Potent CYP2C19/2C9/3A4 inhibitor: raises phenytoin and many other drugs; phenytoin and carbamazepine lower voriconazole levels (phenytoin: increase voriconazole dose, monitor levels)
- QT-prolonging drugs; benzodiazepines and opioids exposure rises
Adverse Effects
- Visual disturbances (photopsia, blurred vision), hallucinations
- Hepatotoxicity
- Phototoxicity and skin cancer risk
- Periostitis from fluoride accumulation with long-term use
- QT prolongation
Monitoring Parameters
- Trough drug levels
- Liver enzymes
- Vision and skin exams on prolonged therapy; ECG with QT drugs
Pregnancy & Lactation
- Teratogenic in animals; avoid in pregnancy unless benefit justifies
- Breastfeeding not recommended