黴菌感染
Treatment of fungal infections in patients ≥2 years of age: Treatment of invasive aspergillosis, esophageal candidiasis, candidemia, disseminated Candida infections, serious fungal infections caused by Scedosporium apiospermum and Fusarium spp

#仿單變更2021

Azole derivative antifungal agent
Interferes with fungal cytochrome P450 activity (selectively inhibits 14-alpha-lanosterol demethylation), decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting fungal cell membrane formation.

Distribution:
1. Extensive tissue distribution; CSF concentration ~50% of plasma concentration
2. Protein binding: 58%
Metabolism:
1. Hepatic, via CYP2C19 (major pathway) and CYP2C9 and CYP3A4 (less significant)
2. Half-life elimination: Variable, dose-dependent. Steady-state is achieved by day 3 when an IV loading dose is administered and between days 5 and 8 if no loading dose is used
Excretion: Urine (<2% as unchanged drug)

1. Hypersensitivity to voriconazole or other azoles
2. Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine, ivabradine<2021/8/10>:
Increased plasma concentrations of these drugs may lead to QT prolongation
3. Co-administration with rifampin, carbamazepine, long-acting barbiturates, ritonavir , efavirenz or rifabutin:
Decrease plasma voriconazole concentrations
4. Co-administration with sirolimus, efavirenz, rifabutin, tolvaptan, or ergot alkaloids:
Voriconazole increases the plasma concentrations of these drugs
5. Pregnancy

D

avoided

visual disturbance, skin rash, liver enzyme elevation

Aspergillosis:
6 mg/kg twice daily for 2 doses, then 4 mg/kg twice daily; duration ≥6 months
Candidiasis:
1. Candidemia: Initial 400 mg IV twice daily for 2 doses, then 200 to 300 mg IV or orally twice daily or weight-based 6 mg/kg IV twice daily for 2 doses, then 3 to 4 mg/kg IV or orally twice daily; duration ≥14 days after first negative blood culture and resolution of symptoms
2. Esophageal: 200 mg twice daily or weight-based 3 mg/kg twice daily for 14 to 28 days
Scedosporiosis:
6 mg/kg twice daily for 2 doses, then 4 mg/kg twice daily

Children <12 years: No data available
Children ≥12 years: Refer to adult dosing

1. CrCl ≥50 mL/minute: No dosage adjustment necessary
2. CrCl <50 mL/minute, hemodialysis: No dosage adjustment necessary; however, use of oral voriconazole or alternative antifungals is preferred if clinically appropriate
3. CRRT, PIRRT: Use of oral voriconazole or alternative antifungals is preferred if clinically appropriate

1. Mild to moderate impairment (Child-Pugh class A or B): Following standard loading dose, reduce maintenance dosage by 50%
2. Severe impairment (Child-Pugh class C): There are no dosage adjustments provided in the manufacturer's labeling; should only be used if benefit outweighs risk, monitor closely for toxicity