Vfend (Voriconazole)
Also sold as: Vfend, Voritek, Voraze, Voriconazole (Cipla), Vori (Glenmark)
Pregnancy
Cat D
Lactation
Avoid
Schedule
H
Forms
Tablet 50mg, 200mg +2
Indications
- Invasive aspergillosis (first-line — IDSA and ESCMID guideline recommended)
- Candidaemia/invasive candidiasis (including fluconazole-resistant Candida)
- Fusariosis
- Scedosporiosis
- Febrile neutropenia (empirical antifungal — alternative)
Adult Dosing
Invasive aspergillosis (oral)
Loading: 400 mg BD × 2 doses on Day 1; Maintenance: 200 mg BD
Take on empty stomach (food reduces absorption by 24%). Adjust if no response (TDM-guided: target trough 1–5.5 mg/L).
Invasive aspergillosis (IV)
Loading: 6 mg/kg IV 12-hourly × 2 doses; Maintenance: 4 mg/kg IV 12-hourly
IV preferred for severe disease. Switch to oral once clinically improved and tolerated.
Candidaemia (non-neutropenic)
200 mg (3 mg/kg) PO/IV BD after loading dose
Minimum 14 days after last positive blood culture and resolution of symptoms
Pediatric Dosing
Children metabolise voriconazole faster — require higher mg/kg doses. TDM essential in paediatrics.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Oral: any CrCl | No adjustment needed for oral formulation |
| IV: CrCl < 50 mL/min | IV formulation CONTRAINDICATED (cyclodextrin vehicle accumulates) — switch to oral |
Hepatic Adjustment
Child-Pugh A/B: use standard dose but monitor LFTs closely. Child-Pugh C: use only if essential (no dose recommendation — very high hepatotoxicity risk).
Pregnancy & Lactation
Pregnancy: Category D
AVOID — teratogenic in animal studies (cleft palate, other skeletal defects). Use only in life-threatening invasive fungal infection when no alternative. Ensure effective contraception in women of childbearing age.
Lactation: Avoid
No data available — avoid. Invasive fungal infections requiring voriconazole typically necessitate suspending breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Rifampicin, rifabutin | CONTRAINDICATED — dramatic reduction in voriconazole levels (CYP induction) | Major |
| Carbamazepine, phenytoin, phenobarbital | Significantly reduce voriconazole levels — avoid or use with therapeutic drug monitoring (TDM) | Major |
| Sirolimus (rapamycin) | CONTRAINDICATED — voriconazole increases sirolimus ~11-fold | Major |
| Ergot alkaloids | CONTRAINDICATED — ergotism (vasospasm) | Major |
| Warfarin | INR increases dramatically — monitor INR daily initially | Major |
| Statins (simvastatin, lovastatin) | Avoid — myopathy risk | Major |
| QT-prolonging drugs (amiodarone, quinidine, methadone) | Additive QT prolongation — avoid or ECG monitoring | Major |
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Side Effects
Common
- Visual disturbances (photopsia — flashes, colour change, blurred vision — common ~30%, usually transient, dose-related)
- Nausea, vomiting
- Hepatotoxicity (elevated LFTs)
- Rash (photosensitivity)
- Headache
- Hallucinations
Serious / Discontinue If
- Hepatotoxicity (fatal rare)
- Phototoxicity (squamous cell carcinoma with long-term use — sun protection essential)
- QT prolongation
- Periostitis (bone pain, long-term fluoride accumulation)
- Teratogenicity
Contraindications
- Concurrent rifampicin, carbamazepine, phenobarbital (long-acting)
- Concurrent sirolimus
- Concurrent ergot alkaloids
- Concurrent rifabutin
- IV form in renal impairment (CrCl < 50)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Voritek 200mg | Cipla | 10 tab ₹3,200 |
| Voraze 200mg | Glenmark | 10 tab ₹3,450 |
| Vfend 200mg | Pfizer | 10 tab ₹7,800 |
Monitoring Required
- LFTs (baseline, weekly for 4 weeks, then monthly)
- Visual function (baseline and if symptoms develop)
- Voriconazole trough levels (TDM: target 1–5.5 mg/L)
- ECG (QTc)
- Serum electrolytes (hypokalaemia, hypomagnesaemia predispose to QT)
- Skin examination (squamous cell carcinoma — long-term sun exposure)
Patient Counseling Points
- Take on an empty stomach — 1 hour before or after meals (food reduces absorption)
- Vision changes (light flashes, colour changes) are common in first weeks — usually improve; avoid driving at night while adjusting
- Strict sun protection required — sunscreen SPF50, protective clothing, avoid prolonged sun exposure
- Report yellow eyes/skin, severe nausea, unusual fatigue — liver problem
- Do not take rifampicin (TB drug) with voriconazole — renders voriconazole ineffective
- Long-term use: annual skin check for sun-related skin cancers
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Clinically reviewed by: Dr. Rajesh Kulkarni, MD (Infectious Diseases), Consultant Infectious Disease Specialist
Last reviewed: 2026-04-01
References
- IDSA Aspergillosis Guidelines 2016 (updated 2020)
- ESCMID/ECMM Aspergillosis Guidelines 2018
- BNF — Voriconazole
- Pfizer Vfend Prescribing Information