Voriconazole is an azole antifungal drug. The primary mode of action of voriconazole is the inhibition of fungal cytochrome P-450-mediated 14 alpha-lanosterol demethylation, an essential step in fungal ergosterol biosynthesis.

VFEND is an azole antifungal indicated for the treatment of adults and pediatric patients 2 years of age and older with: Invasive aspergillosis; Candidemia in non-neutropenics and other deep tissue Candida infections; Esophageal candidiasis; Serious fungal infections caused by Scedosporium apiospermum and Fusarium species including Fusarium solani, in patients intolerant of, or refractory to, other therapy.

Invasive Aspergillosis: Loading dose: Intravenous infusion 6 mg/kg every 12 hours for the first 24 hours. Maintenance Dose: Intravenous infusion 4 mg/kg every 12 hours; Oral 200 mg every 12 hours. (See Full Prescribing Information.)

Adult Patients: The most common adverse reactions (incidence ≥2%) were visual disturbances, fever, nausea, rash, vomiting, chills, headache, liver function test abnormal, tachycardia, hallucinations. Pediatric Patients: The most common adverse reactions (incidence ≥5%) were visual disturbances, pyrexia, vomiting, epistaxis, nausea, rash, abdominal pain, diarrhea, hypertension, hypokalemia, cough, headache, thrombocytopenia, ALT abnormal, hypotension, peripheral edema, hyperglycemia, tachycardia, dyspnea, hypocalcemia, hypophosphatemia, LFT abnormal, mucosal inflammation, tachycardia, dyspnea, hypocalcemia, hypophosphatemia, LFT abnormal, mucosal inflammation, photophobia, abdominal distention, constipation, dizziness, hallucinations, hemoptysis, hypoalbuminemia, hypomagnesemia, renal impairment, upper respiratory tract infection.

Hypersensitivity to voriconazole or its excipients. Coadministration with pimozide, quinidine, sirolimus or ivabradine due to risk of serious adverse reactions. Coadministration with rifampin, carbamazepine, long-acting barbiturates, efavirenz, ritonavir, rifabutin, ergot alkaloids, and St. John's Wort due to risk of loss of efficacy. Coadministration with naloxegol, tolvaptan, and lurasidone due to risk of adverse reactions. Coadministration of VFEND with venetoclax at initiation and during the ramp-up phase in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) due to increased risk of adverse reactions.

Hepatic Toxicity: Serious hepatic reactions reported. Evaluate liver function tests at start of and duringVFEND therapy. Arrhythmias and QT Prolongation: Correct potassium, magnesium and calcium prior to use; caution patients with proarrhythmic conditions. Infusion Related Reactions (including anaphylaxis): Stop the infusion. Visual Disturbances (including optic neuritis and papilledema): Monitor visual function if treatment continues beyond 28 days. Severe Cutaneous Adverse Reactions: Discontinue for exfoliative cutaneous reactions. Photosensitivity: Avoid sunlight due to risk of photosensitivity. Adrenal Dysfunction: Carefully monitor patients receiving VFEND and corticosteroids (via all routes of administration) for adrenal dysfunction both during and after VFEND treatment. Instruct patients to seek immediate medical care if they develop signs and symptoms of Cushing's syndrome or adrenal insufficiency. (See Full Prescribing Information.)