Votab

Indications

Voriconazole is a strong antifungal medicine used for serious and life-threatening fungal infections, usually in hospital or under a specialist, including:

• Invasive aspergillosis (a serious mould infection, often of the lungs).
• Serious Candida infections of the blood and deep tissues, and Candida infection of the food pipe.
• Serious infections caused by rarer fungi such as Scedosporium and Fusarium.
• Prevention of fungal infections in some high-risk patients, such as after bone marrow transplant.

How It Works

Voriconazole blocks the making of ergosterol, an essential part of the fungal cell membrane. Without it, the fungus cannot grow and spread.

Dosage and Administration

The dose is set by the specialist according to the infection, body weight and how the patient responds. Treatment usually starts with a higher loading dose on the first day, followed by a lower maintenance dose, as prescribed. The injection is given as a slow drip into a vein by a doctor or nurse in hospital. Tablets are taken at least 1 hour before or 1 hour after a meal. Children: as prescribed. Blood levels may be checked to adjust the dose.

Interactions

Voriconazole interacts with many medicines. It must not be taken with Rifampicin, Rifabutin, Carbamazepine, long-acting barbiturates such as Phenobarbital, high-dose Ritonavir, high-dose Efavirenz, Sirolimus, Pimozide, Quinidine, ergot medicines or St John's wort. It raises levels of Ciclosporin, Tacrolimus, Warfarin, some statins, Omeprazole, Midazolam and some cancer medicines, so doses may need changing. Phenytoin lowers its level. Tell the doctor about every medicine, herbal product and supplement you take.

Contraindications

• Allergy to voriconazole or any ingredient of the product.
• Use with any of the medicines that must not be combined with it (see Interactions).

Side Effects

Common: temporary vision changes (blurred vision, changes in colour vision, sensitivity to light), rash, fever, nausea, vomiting, diarrhoea, headache, swelling of the legs, and changes in liver tests. Some people have hallucinations or confusion. Long-term use can make the skin very sensitive to sunlight and raise the risk of skin cancer.

Get urgent medical help for yellow skin or eyes, dark urine, severe stomach pain, a blistering or peeling rash, fainting, a fast or irregular heartbeat, severe sunburn, or swelling of the face or throat with difficulty breathing.

Pregnancy and Lactation

Voriconazole should not be used in pregnancy unless the doctor decides the benefit clearly outweighs the risk, as it can harm the unborn baby. Women who could become pregnant should use effective contraception during treatment. Breastfeeding should be stopped during treatment.

Precautions and Warnings

• Liver tests, kidney tests and blood salts (potassium, magnesium and calcium) are checked during treatment; an ECG may be done for heart rhythm.
• Avoid sunlight and sunbeds; cover up and use high-factor sunscreen.
• Do not drive or operate machinery if vision is affected.
• Tell the doctor about liver disease, heart rhythm problems, or kidney problems (relevant to the injection).
• Take the full course as prescribed.

Overdose

Overdose may cause light sensitivity, vision changes and heart rhythm problems. It must be managed in hospital. Get urgent medical help if too much has been taken.

Therapeutic Class

Triazole antifungal.

Storage

Store tablets below 30°C in a dry place, away from light. Injection vials are stored and prepared by hospital staff as the label directs. Keep out of reach of children.