Vorizol (Voriconazole)

Triazole Antifungal Agent

Indications

Indicated for patients 12 years of age and older for the treatment of:

• Invasive Aspergillosis

• Candidemia (nonneutropenic) and disseminated Candida infections (skin, abdomen, kidney, bladder wall, and wounds)

• Esophageal Candidiasis

• Serious fungal infections caused by Scedosporium apiospermum and Fusarium species (including Fusarium solani)

• Patients intolerant of or refractory to other therapies

Note: Take strictly as directed by a registered physician.

Mechanism of Action

Voriconazole inhibits ergosterol synthesis by blocking CYP450-dependent 14-alpha sterol demethylase, disrupting fungal cell membrane integrity.

Dosage & Administration

Oral (Tablets & Suspension)

Must be taken at least 1 hour before or 1 hour after a meal.

• Weight $\ge$ 40 kg:

  • Loading Dose (First 24 hrs): 400 mg (10 mL) every 12 hours

  • Maintenance Dose: 200 mg (5 mL) twice daily

• Weight < 40 kg:

  • Loading Dose (First 24 hrs): 200 mg (5 mL) every 12 hours

  • Maintenance Dose: 100 mg (2.5 mL) twice daily

Intravenous Injection

• Invasive Aspergillosis, Scedosporiosis & Fusariosis:

  • Loading: 6 mg/kg every 12 hours for 24 hours

  • Maintenance: 4 mg/kg every 12 hours

• Candidemia & Deep Tissue Candida Infections:

  • Loading: 6 mg/kg every 12 hours for 24 hours

  • Maintenance: 3–4 mg/kg every 12 hours

Drug Interactions

• CYP2C9, CYP2C19, & CYP3A4 Inhibitors/Inducers: Dose adjustments and monitoring required.

• CYP Substrates: Vorizol may increase blood levels of co-administered drugs metabolized by these enzymes.

• Phenytoin or Efavirenz: May require increased Vorizol maintenance doses.

Contraindications

• Known hypersensitivity to voriconazole or any excipient.

• Do NOT co-administer with:

  • Terfenadine, astemizole, cisapride, pimozide, quinidine, or sirolimus (risk of severe toxicity).

  • Rifampin, carbamazepine, long-acting barbiturates, efavirenz, ritonavir, rifabutin, ergot alkaloids, or St. John's Wort (risk of treatment failure).

Side Effects & Warnings

• Common Side Effects: Abdominal pain, anemia, blurred vision, headache, chest pain, nausea, and diarrhea.

• Long-Term Risk: Treatment exceeding 180 days increases the risk of Squamous Cell Carcinoma (SCC) of the skin; requires continuous risk-benefit evaluation.

• Pregnancy & Lactation: Use only if potential benefits outweigh risks to the fetus.

• Pediatric Use: Safety and efficacy in children under 12 are not established.

Preparation & Storage

• Suspension Reconstitution: Shake bottle to loosen powder. Add 25 mL of boiled, cooled water. Shake vigorously.

• Storage:

  • Dry powder for suspension: Store at 2°C–8°C.

  • Reconstituted suspension: Store at 15°C–30°C; discard after 14 days.

  • Tablets/General: Keep below 25°C, away from light and out of reach of children.