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Voriconazole parenteral

Updated 2 Feb 2023 | Triazole antifungals


Parenteral formulations of voriconazole.

Drugs List

  • VFEND 200mg powder for solution for infusion vial
  • voriconazole 200mg powder for solution for infusion vial
  • Therapeutic Indications


    Aspergillosis: treatment
    Invasive candidiasis in non-neutropenic adults
    Prophylaxis of fungal infection in haematopoietic stem cell transplant pts
    Serious fungal infections
    Treatment of candidosis when other treatment unsuitable/ineffective


    Voriconazole has high oral bioavailability and switching between intravenous and oral administration is appropriate, when clinically indicated.

    Treatment duration should be as short as possible depending on the patient's clinical and mycological response. Treatment duration longer than 6 months requires careful assessment of the benefit to risk balance.

    Initiate on the day of transplant and administer for up to 100 days. Treatment may continue for 6 months in case of continuing immunosuppression or graft versus host disease. Dose adjustments are not recommended in instances of lack of efficacy or voriconazole related adverse reactions. Consider discontinuing voriconazole in the event of adverse effects.


    Loading dose
    6mg/kg every 12 hours, for 24 hours.

    Maintenance dose
    Recommended dose
    4mg/kg twice a day.
    Reduced dose (if poorly tolerated)
    3mg/kg twice a day.


    Children should begin on the intravenous regimen, and may only progress onto oral therapy once a significant clinical improvement has been made.

    Children aged 15 to 18 years
    (See Dosage; Adult)

    Children aged 12 to 15 years with a bodyweight 50kg and above
    (See Dosage; Adult)

    Children 2 to 15 years with bodyweight below 50kg
    Initial dose
    9mg/kg every 12 hours, for 24 hours.
    Maintenance dose
    Recommended dose: 8mg/kg twice a day.
    Dose modification: May be increased or decreased in steps of 1mg/kg, dependent on patient's response.

    Patients with Renal Impairment

    All patients with renal impairment
    Oral formulations are preferable for patients with renal impairment, unless an assessment of the risks and benefits to the patient justify the use of intravenous voriconazole.

    Children aged 2 up to 12 years with renal impairment
    Voriconazole has not been studied in this population.

    Patients with Hepatic Impairment

    Mild and moderate hepatic impairment (Child-Pugh A and B)
    Loading dose: 100% of normal.
    Maintenance dose: 50% of normal.

    Severe hepatic impairment (Child-Pugh score C)
    Voriconazole has not been studied in this population.

    Children aged 2 up to 12 years with hepatic impairment
    Voriconazole has not been studied in this population.


    For administration as an intravenous infusion after reconstitution and dilution.

    It should be given at a maximum rate of 3 mg/kg per hour over 1 to 3 hours.


    Children under 2 years
    Long QT syndrome
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Restricted sodium intake
    Acute pancreatitis
    Electrolyte imbalance
    Haematological malignancy
    Hepatic impairment
    History of torsade de pointes
    Renal impairment - creatinine clearance below 50ml/minute

    Correct electrolyte disorders before treatment
    Reduce maintenance dose in hepatic impairment
    Sodium content of formulation may be significant
    Some formulations contain more than 1mmol (23mg) sodium per dose
    Advise ability to drive/operate machinery may be affected by side effects
    Monitor hepatic function before treatment and regularly during treatment
    Consider monitoring ECG in patients at risk of QT prolongation
    If rash develops, consider possibility of Stevens-Johnson Syndrome
    Liver function tests recommended - withdraw therapy if abnormal
    May cause adrenal suppression
    Monitor for signs of cutaneous squamous cell carcinoma
    Monitor patient for infusion-associated reactions (IARs)
    Monitor renal function regularly
    Monitor serum amylase in patients at risk of pancreatitis
    Monitor serum creatinine in patients with renal impairment
    Monitor serum electrolytes
    Monitor serum lipase in patients at risk of pancreatitis
    Refer phototoxic reactions to dermatologist
    Advise patient to seek medical advice if severe skin reaction occurs
    Advise patients to report signs of hepatic damage (malaise, jaundice etc.)
    Consider discontinuing if phototoxic reaction occurs
    Consider discontinuing if signs and symptoms of periostitis occur
    Discontinue if premalignant skin lesions/squamous cell carcinoma occur
    Withdraw drug in the case of worsening rash or severe skin reactions
    Maximum treatment duration is 6 months
    Advise patient not to take St John's wort concurrently
    Female: Ensure adequate contraception during treatment
    Advise patient on appropriate sun protection methods
    Advise patient to avoid exposure to direct sunlight
    Advise patients that phototoxic reactions may occur
    Advise patients to report skin rash

    Monitor hepatic function (specifically AST and ALT) before starting treatment, at least weekly for 1 month, and then monthly during treatment. If hepatic function tests become markedly elevated voriconazole should be discontinued, unless the benefit of continuing treatment outweighs the risk to the patient.

    Cases of reversible adrenal insufficiency have been reported with voriconazole usage. Patients should be monitored for adrenal cortex dysfunction during and after treatment, and seek immediate medical care if they experience signs of adrenal insufficiency or Cushing's syndrome.

    If phototoxic reactions occur and treatment is continued, dermatologic evaluation should occur regularly for early detection of premalignant lesions.

    Pregnancy and Lactation


    Voriconazole is contraindicated in pregnancy.

    At the time of writing, there is limited information on the use of voriconazole during pregnancy. The manufacturers suggest voriconazole must not be used during pregnancy unless the benefit to the mother clearly outweighs the potential risk to the foetus.

    It is unknown whether voriconazole crosses the placenta. The molecular weight is low enough that exposure to the embryo and/or foetus should be expected. Briggs suggests a theoretical risk of teratogenicity, and states that voriconazole should be avoided in the first trimester.

    Studies in animals have shown reproductive toxicity.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Voriconazole is contraindicated in breastfeeding.

    The low molecular weight suggests that voriconazole will be excreted into breast milk. There is potential for toxicity in breastfeeding infants especially during the neonatal period when hepatic function is immature.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abnormal liver function tests
    Acute renal failure
    Adrenal cortex insufficiency
    Anaphylactoid reaction
    Back pain
    Blood dyscrasias
    Bone marrow depression
    Bundle branch block
    Cardiac arrhythmias
    Cerebral oedema
    Chest pain
    Complete AV block
    Corneal opacities
    Discoid lupus erythematosus
    Erythema multiforme
    Exfoliative dermatitis
    Extrapyramidal effects
    Gastro-intestinal symptoms
    Guillain-Barre syndrome
    Hepatic coma
    Hepatic failure
    Hypersensitivity reactions
    Increase in creatinine
    Injection site reactions
    Intravascular coagulation (disseminated)
    Mood changes
    Musculoskeletal disturbances
    Optic atrophy
    Optic neuritis
    Peripheral neuropathy
    Prolongation of QT interval
    Pseudomembranous colitis
    Psychiatric disorders
    Pulmonary oedema
    Renal tubular necrosis
    Respiratory distress
    Retinal haemorrhage
    Serum bilirubin increased
    Skin disorder
    Skin photosensitivity
    Squamous cell carcinoma
    Stevens-Johnson syndrome
    Taste disturbances
    Torsades de pointes
    Toxic epidermal necrolysis
    Vasovagal attacks
    Visual disturbances


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2019

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    Summary of Product Characteristics: VFEND 40 mg/ml powder for oral suspension. Pfizer Ltd. Revised February 2022.

    Summary of Product Characteristics: VFEND 50mg Film-Coated Tablets. Pfizer Ltd. Revised February 2022.
    Summary of Product Characteristics: VFEND 200mg Film-Coated Tablets. Pfizer Ltd. Revised February 2022.

    Summary of Product Characteristics: VFEND 200 mg powder and solvent for solution for infusion. Pfizer Ltd. Revised December 2018.
    Summary of Product Characteristics: VFEND 200 mg powder for solution for infusion. Pfizer Ltd. Revised February 2022.

    Summary of Product Characteristics: Voriconazole 200mg powder for solution for infusion. Actavis Ltd. Revised March 2017.
    Summary of Product Characteristics: Voriconazole 200mg powder for solution for infusion. Aspire Pharma Ltd. Revised October 2017.

    NICE - Evidence Services
    Available at:
    Last accessed: 19 February 2019

    The Drug Database for Acute Porphyria (NAPOS)
    Available at:
    Last accessed: 19 February 2019.

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