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

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.

Absorption:
Oral bioavailability: 96%
Distribution:
Plasma protein bounding: 51-67%
Metabolism:
Cytochrome P450 enzyme, CYP2C19 is the major isoenzyme involved in metabolism
Excretion:
Less than 2% of the dose is excreted unchanged by the kidney. The elimination half-life is about 6 hours

1. Hypersensitivity to voriconazole or other azoles
2. Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine, ivabradine:
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, or ergot alkaloids:
Voriconazole increases the plasma concentrations of these drugs
5. Pregnancy

D

avoided

visual disturbance, skin rash, liver enzyme elevation

Aspergillosis:
200 mg twice daily; may increase to 300 mg twice daily based on therapeutic drug monitoring
Candidiasis:
1. Candidemia: Step-down therapy 200 mg twice daily; for susceptible isolates of Candida glabrata, use 200-300 mg twice daily; duration ≥14 days
2. Esophageal: 200 mg twice daily or weight-based 3 mg/kg twice daily for 14 to 28 days
Scedosporiosis:
400 mg twice daily for 2 doses, then 200 to 300 mg 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
3. CRRT, PIRRT: No dosage adjustment necessary

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