Indications

Voricare (Voriconazole) is an azole antifungal medicine for patients 12 years of age and older. It is indicated for the treatment of:

• Invasive aspergillosis.
• Candidemia (in non-neutropenic patients) and disseminated candidiasis in various body parts.
• Esophageal candidiasis.
• Serious infections caused by Scedosporium apiospermum and Fusarium species. It is also used for patients who are intolerant of or refractory to other therapies.

Pharmacology

Voriconazole is a triazole antifungal medication that inhibits the synthesis of ergosterol, a key component of fungal cell membranes. It achieves this by binding to and inhibiting a specific enzyme, CYP450-dependent 14-alpha sterol demethylase, which leads to the depletion of ergosterol.

Dosage & Administration

• Oral (Tablets & Suspension):
  • Take at least one hour before or one hour after a meal.
  • Patients $\ge$ 40 kg:
    • Loading Dose: 400 mg every 12 hours for the first 24 hours.
    • Maintenance Dose: 200 mg twice daily.
  • Patients < 40 kg:
    • Loading Dose: 200 mg every 12 hours for the first 24 hours.
    • Maintenance Dose: 100 mg twice daily.
• Injection:
  • Loading Dose: 6 mg/kg every 12 hours for the first 24 hours for all indications.
  • Maintenance Dose: Varies based on indication (3-4 mg/kg or 4 mg/kg every 12 hours).

Interaction

• CYP Inhibitors & Inducers: Voricare's dosage may need adjustment, and patients should be monitored for efficacy or adverse reactions.
• CYP Substrates: Voricare may increase the concentration of other drugs that are substrates of CYP3A4, CYP2C9, and CYP2C19. Doses of these other drugs may need to be reduced.
• Phenytoin or Efavirenz: The maintenance dose of Voricare should be increased when co-administered.

Contraindications

Voricare is contraindicated in patients with:

• Known hypersensitivity to Voriconazole or its components.
• Co-administration with terfenadine, astemizole, cisapride, pimozide, quinidine, or sirolimus due to the risk of serious adverse reactions.
• Co-administration with rifampin, carbamazepine, long-acting barbiturates, efavirenz, ritonavir, rifabutin, ergot alkaloids, and St. John's Wort due to the risk of loss of efficacy.

Side Effects

The most common side effects are abdominal pain, anemia, blurred vision, headache, chest pain, nausea, and diarrhea.

Pregnancy & Lactation

There are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus.

Precautions & Warnings

• Long-term use (over 180 days) requires a careful assessment of the benefit-risk balance.
• Squamous cell carcinoma of the skin (SCC) has been reported with long-term treatment.

Use in Special Populations

The efficacy and safety of Voricare in children under 12 years of age have not been established.

Therapeutic Class

Voricare belongs to the class of other antifungal preparations.

Reconstitution (Suspension)

To reconstitute, shake the bottle to loosen the powder. Add 25 ml of boiled and cooled water. Shake vigorously until the powder is completely mixed. The reconstituted suspension should be stored between 15°C and 30°C and must be discarded after 14 days.

Storage Conditions

Keep out of reach of children. Store in a dry place, below 25°C, and protected from light. Store the powder for suspension between 2°C and 8°C.