Vanazole Dosage/Direction for Use

The following oral loading doses of voriconazole are given every 12 hours for the first 24 hours: Adults and adolescents weighing more than 40 kg: 400 mg.
Under 40 kg: 200 mg.
Subsequent oral maintenance doses are: Adults and adolescents over 40 kg: 200 mg twice daily, increased to 300 mg twice daily if the response is inadequate.
Under 40 kg: 100 mg twice daily, increased to 150 mg twice daily if the response is inadequate.
US licensed product information does not suggest a loading dose for oesophageal candidiasis; oral maintenance doses are as above and treatment should be given for a minimum of 14 days and continued for at least 7 days after resolution of symptoms.
Dosage adjustment in patients receiving concomitant CYP450 enzyme inducer or substrates: Cyclosporine: Reduce cyclosporine dose by one-half and monitor closely; upon discontinuation of voriconazole, monitor cyclosporine concentrations and escalate the cyclosporine dose as needed.
Efavirenz: Increase maintenance dose of voriconazole to 400 mg every 12 hours and reduce efavirenz dose to 300 mg once daily; upon discontinuation of voriconazole, return to the initial dose of efavirenz.
Omeprazole: Reduce omeprazole dose by one-half in patients maintained on ≥40 mg/day of omeprazole.
Phenytoin: Increase voriconazole dose to 400 mg every 12 hours in patients ≥40 kg (200 mg every 12 hours in patients <40 kg).
Tacrolimus: Reduce tacrolimus dose by one-third and monitor closely; upon discontinuation of voriconazole, monitor tacrolimus concentrations and escalate the tacrolimus dose as needed.
Dosage adjustment in renal impairment: No dose adjustment is needed for oral voriconazole in patients with renal impairment. Patients with a creatinine clearance less than 50 ml/minute should receive oral voriconazole instead of intravenous voriconazole as accumulation of intravenous vehicle may occur.
Dosage adjustment in hepatic impairment: Mild to moderate hepatic dysfunction (Child-Pugh class A and B): Following standard loading dose, reduce maintenance dosage by 50%.
Severe hepatic impairment: Should only be used if benefit outweighs risk; monitor closely for toxicity.
Method of Administration: Voriconazole should be taken at least 1 hour before, or 1 hour after a meal.