Voriconazole

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Dosing Notes
All Indications, IV Route 6mg/kg IV Q12h x 2 doses, then 4mg/kg IV Q12hr Risk/benefit consideration for IV formulation for CrCl<50 mL/min, as IV vehicle accumlates; consider PO

All Indications, PO Route

In obese patients consider a weight-based PO regimen (4mg/kg q12H based on adjusted body weight), Consult ID or ASP for assistance. 

400mg PO Q12h x doses, then 200mg PO Q12* No renal dose adjustment

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Dosing Notes
All Indications, IV Route 6mg/kg IV Q12h x 2 doses, then 4mg/kg IV Q12hr No dose adjustment in hemodialysis

All Indications, PO Route

In obese patients consider a weight-based PO regimen (4mg/kg q12H ADJ BW), Consult ID or ASP for assistance. 

400mg PO Q12h x doses, then 200mg PO Q12 No dose adjustment in hemodialysis

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Review medications for potential drug interactions.

Voriconazole has high inter- and intra-patient variability.  Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

See UCSF Lab Voriconazole Recommendations  for specifics of monitoring.

Unrestricted Indications:

1) Prophylaxis against fungal infections on the hematology/BMT/lung transplant services 

2) Suspected or documented fungal pneumonia in the hematology/BMT/lung tranpslant services

3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

0

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Dosing Notes
All Indications, IV Route 6mg/kg IV Q12h x 2 doses, then 4mg/kg IV Q12hr Risk/benefit consideration for IV formulation for CrCl<50 mL/min, as IV vehicle accumlates; consider PO

All Indications, PO Route

In obese patients consider a weight-based PO regimen (4mg/kg q12H based on adjusted body weight), Consult ID or ASP for assistance. 

400mg PO Q12h x doses, then 200mg PO Q12* No renal dose adjustment

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Dosing Notes
All Indications, IV Route 6mg/kg IV Q12h x 2 doses, then 4mg/kg IV Q12hr No dose adjustment in hemodialysis

All Indications, PO Route

In obese patients consider a weight-based PO regimen (4mg/kg q12H ADJ BW), Consult ID or ASP for assistance. 

400mg PO Q12h x doses, then 200mg PO Q12 No dose adjustment in hemodialysis

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Review medications for potential drug interactions.

Voriconazole has high inter- and intra-patient variability.  Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

See UCSF Lab Voriconazole Recommendations  for specifics of monitoring.

Unrestricted Indications:

1) Prophylaxis against fungal infections on the hematology/BMT/lung transplant services 

2) Suspected or documented fungal pneumonia in the hematology/BMT/lung tranpslant services

3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

1

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Dosing Notes
All Indications, IV Route 6mg/kg IV Q12h x 2 doses, then 4mg/kg IV Q12hr Risk/benefit consideration for IV formulation for CrCl<50 mL/min, as IV vehicle accumlates; consider PO

All Indications, PO Route

In obese patients consider a weight-based PO regimen (4mg/kg q12H based on adjusted body weight), Consult ID or ASP for assistance. 

400mg PO Q12h x doses, then 200mg PO Q12* No renal dose adjustment

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Dosing Notes
All Indications, IV Route 6mg/kg IV Q12h x 2 doses, then 4mg/kg IV Q12hr No dose adjustment in hemodialysis

All Indications, PO Route

In obese patients consider a weight-based PO regimen (4mg/kg q12H ADJ BW), Consult ID or ASP for assistance. 

400mg PO Q12h x doses, then 200mg PO Q12 No dose adjustment in hemodialysis

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Review medications for potential drug interactions.

Voriconazole has high inter- and intra-patient variability.  Voriconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 3-5 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

See UCSF Lab Voriconazole Recommendations  for specifics of monitoring.

Unrestricted Indications:

1) Prophylaxis against fungal infections on the hematology/BMT/lung transplant services 

2) Suspected or documented fungal pneumonia in the hematology/BMT/lung tranpslant services

3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

2