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  • CLASSES

    Azole Antifungals

    DEA CLASS

    Rx

    DESCRIPTION

    IV and oral azole antifungal drug
    Indicated for aspergillosis, candidiasis, candidemia, and as salvage therapy for Scedosporium and Fusarium sp. infections
    Associated with visual disturbances, QT prolongation, and phototoxicity

    COMMON BRAND NAMES

    VFEND

    HOW SUPPLIED

    VFEND/Voriconazole Intravenous Inj Pwd F/Sol: 200mg
    VFEND/Voriconazole Oral Pwd F/Recon: 1mL, 40mg
    VFEND/Voriconazole Oral Tab: 50mg, 200mg

    DOSAGE & INDICATIONS

    For the treatment of candidemia and other serious invasive candidiasis infections.
    NOTE: The manufacturer recommends use in nonneutropenic patients only.
    Intravenous dosage
    Adults

    6 mg/kg/dose IV every 12 hours on day 1, followed by 3 to 4 mg/kg/dose IV every 12 hours. In clinical trials, patients with candidemia received 3 mg/kg/dose IV every 12 hours, and patients with other deep tissue Candida infections received 4 mg/kg/dose IV every 12 hours. Selection of the appropriate dose should be based on the nature and severity of the infection. If patient is unable to tolerate 4 mg/kg/dose IV, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Adolescents 15 to 17 years

    6 mg/kg/dose IV every 12 hours on day 1, followed by 3 to 4 mg/kg/dose IV every 12 hours. In clinical trials, patients with candidemia received 3 mg/kg/dose IV every 12 hours, and patients with other deep tissue Candida infections received 4 mg/kg/dose IV every 12 hours. Selection of the appropriate dose should be based on the nature and severity of the infection. If patient is unable to tolerate 4 mg/kg/dose IV, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    6 mg/kg/dose IV every 12 hours on day 1, followed by 3 to 4 mg/kg/dose IV every 12 hours. In clinical trials, patients with candidemia received 3 mg/kg/dose IV every 12 hours, and patients with other deep tissue Candida infections received 4 mg/kg/dose IV every 12 hours. Selection of the appropriate dose should be based on the nature and severity of the infection. If patient is unable to tolerate 4 mg/kg/dose IV, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Children 2 to 11 years

    9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years not well established. 9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours is recommended by guidelines. This dose has been shown to provide comparable exposure in children 2 to 11 years to adults receiving 6 mg/kg/dose IV every 12 hours on day 1, followed by 4 mg/kg/dose IV every 12 hours.[54736] [54737] [60487] A maintenance dose of 4 mg/kg/dose every 12 hours in children provided comparable exposure to that seen in adults receiving 3 mg/kg/dose every 12 hours.[32393] [54736] However, it is unknown if this dosing strategy will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years.[54753] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[60487] Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations.[54742] [54743] [54744] [54745] [54747] [54755] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Oral dosage
    Adults weighing 40 kg or more

    200 mg PO every 12 hours after IV loading dose. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours.[28158] Alternatively, guidelines suggest 400 mg PO every 12 hours for 2 doses, followed by maintenance dosage.[60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Adults weighing less than 40 kg

    100 mg PO every 12 hours after IV loading dose. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours.[28158] Alternatively, guidelines suggest 400 mg PO every 12 hours for 2 doses, followed by maintenance dosage.[60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Adolescents 15 to 17 years weighing 40 kg or more

    200 mg PO every 12 hours after IV loading dose. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours.[28158] Alternatively, guidelines suggest 400 mg PO every 12 hours for 2 doses, followed by maintenance dosage.[60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Adolescents 15 to 17 years weighing less than 40 kg

    100 mg PO every 12 hours after IV loading dose. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours.[28158] Alternatively, guidelines suggest 400 mg PO every 12 hours for 2 doses, followed by maintenance dosage.[60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    200 mg PO every 12 hours after IV loading dose. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Alternatively, guidelines suggest 400 mg PO every 12 hours for 2 doses, followed by maintenance dosage. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications. Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) after IV loading dose. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Children 2 to 11 years

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) after IV loading dose. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications.[28158] Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.[60487]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years not well established. 9 mg/kg/dose PO every 12 hours is recommended by guidelines and this dose has been shown to provide comparable exposure in children 2 to 11 years as adults receiving 200 mg PO every 12 hours. However, it is unknown if this dose will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Treat for at least 14 days after resolution of symptoms or last positive culture, whichever is longer, for candidemia without metastatic complications. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years and with oral administration, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations. Guidelines recommend voriconazole as alternative therapy for nonneutropenic patients with C. krusei or C. glabrata infections and additional mold coverage for neutropenic patients if desired. If the central venous catheter is the presumed source of infection, consider early catheter removal. In addition, all patients should undergo a dilated ophthalmological examination, preferably performed by an ophthalmologist within the first week after diagnosis or recovery from neutropenia.

    For the primary treatment of invasive aspergillosis.
    Intravenous dosage
    Adults

    6 mg/kg/dose IV every 12 hours on day 1, followed by 4 mg/kg/dose IV every 12 hours. If patient is unable to tolerate maintenance therapy, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Higher dosages have been used in some case reports.[26836] [26837] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Adolescents 15 to 17 years

    6 mg/kg/dose IV every 12 hours on day 1, followed by 4 mg/kg/dose IV every 12 hours. If patient is unable to tolerate maintenance therapy, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Higher dosages have been used in some case reports.[26836] [26837] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    6 mg/kg/dose IV every 12 hours on day 1, followed by 4 mg/kg/dose IV every 12 hours. If patient is unable to tolerate maintenance therapy, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Higher dosages have been used in some case reports.[26836] [26837] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Children 2 to 11 years

    9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years not well established. 9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours is recommended by guidelines. This dose has been shown to provide comparable exposure in children 2 to 11 years to adults receiving 6 mg/kg/dose IV every 12 hours on day 1, followed by 4 mg/kg/dose IV every 12 hours.[54736] [54737] [61353] A maintenance dose of 4 mg/kg/dose every 12 hours in children provided comparable exposure to that seen in adults receiving 3 mg/kg/dose every 12 hours.[32393] [54736] However, it is unknown if this dosing strategy will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years.[54753] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations.[54742] [54743] [54744] [54745] [54747] [54755] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Oral dosage
    Adults weighing 40 kg or more

    200 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Adults weighing less than 40 kg

    100 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Adolescents 15 to 17 years weighing 40 kg or more

    200 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Adolescents 15 to 17 years weighing less than 40 kg

    100 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    200 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) beginning after at least 7 days of IV voriconazole therapy. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Children 2 to 11 years

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) beginning after at least 7 days of IV voriconazole therapy. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years is not well established. 9 mg/kg/dose PO every 12 hours is recommended by guidelines. This dose has been shown to provide comparable exposure in children 2 to 11 years as adults receiving 200 mg PO every 12 hours.[54736] [61353] However, it is unknown if this dose will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years.[54753] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years and with oral administration, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations.[54742] [54743] [54744] [54745] [54747] [54755] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353]

    For the treatment of CNS infections, including meningitis.
    For step-down therapy of CNS infections due to Blastomyces dermatitidis† after initial treatment with amphotericin B .
    Oral dosage
    Adults

    200 to 400 mg PO twice daily for at least 12 months and until resolution of CSF abnormalities. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[34215]

    Adolescents 15 to 17 years

    200 mg PO twice daily for at least 12 months and until resolution of CSF abnormalities. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    200 mg PO twice daily for at least 12 months and until resolution of CSF abnormalities. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg PO twice daily for at least 12 months and until resolution of CSF abnormalities. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Children 2 to 11 years

    9 mg/kg PO twice daily for at least 12 months and until resolution of CSF abnormalities. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    For the treatment of CNS infections due to Aspergillus sp..
    Intravenous dosage
    Adults

    6 mg/kg/dose IV every 12 hours on day 1, then 4 mg/kg/dose IV every 12 hours. If patient is unable to tolerate maintenance therapy, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks, with duration dependent on level of immunosuppression, extent of disease, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Adolescents 15 to 17 years

    6 mg/kg/dose IV every 12 hours on day 1, then 4 mg/kg/dose IV every 12 hours. If patient is unable to tolerate maintenance therapy, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    6 mg/kg/dose IV every 12 hours on day 1, then 4 mg/kg/dose IV every 12 hours. If patient is unable to tolerate maintenance therapy, reduce dose to 3 mg/kg/dose IV every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose IV every 12 hours on day 1, then 8 mg/kg/dose IV every 12 hours. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Children 2 to 11 years

    9 mg/kg/dose IV every 12 hours on day 1, then 8 mg/kg/dose IV every 12 hours. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Stepdown to oral therapy can be considered after 7 days if there is clinical improvement.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Infants and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years not well established. 9 mg/kg/dose IV every 12 hours on day 1, then 8 mg/kg/dose IV every 12 hours is recommended by guidelines. This dose has been shown to provide comparable exposure in children 2 to 11 years to adults receiving 6 mg/kg/dose IV every 12 hours on day 1, then 4 mg/kg/dose IV every 12 hours.[54736] [54737] [61353] A maintenance dose of 4 mg/kg/dose every 12 hours in children provided comparable exposure to that seen in adults receiving 3 mg/kg/dose every 12 hours.[32393] [54736] However, it is unknown if this dosing strategy will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years.[54753] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations.[54742] [54743] [54744] [54745] [54747] [54755] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Oral dosage
    Adults weighing 40 kg or more

    200 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Adults weighing less than 40 kg

    100 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Adolescents 15 to 17 years weighing 40 kg or more

    200 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Adolescents 15 to 17 years weighing less than 40 kg

    100 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    200 mg PO every 12 hours beginning after at least 7 days of IV voriconazole therapy. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) beginning after at least 7 days of IV voriconazole therapy. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Children 2 to 11 years

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) beginning after at least 7 days of IV voriconazole therapy. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years is not well established. 9 mg/kg/dose PO every 12 hours is recommended by guidelines. This dose has been shown to provide comparable exposure in children 2 to 11 years as adults receiving 200 mg PO every 12 hours.[54736] [61353] However, it is unknown if this dose will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years.[54753] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years and with oral administration, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations.[54742] [54743] [54744] [54745] [54747] [54755] Guidelines suggest voriconazole as primary therapy. Treat for at least 6 to 12 weeks with duration dependent on extent and length of immunosuppression, infection site, and disease improvement.[61353] Longer treatment is often necessary. In a retrospective study of patients with CNS aspergillosis, the median duration of voriconazole treatment was 51 days (range, 1 to 1,128 days).[61956]

    For the treatment of CNS infections due to Coccidioides sp.†.
    Oral dosage
    Adults

    200 to 400 mg PO every 12 hours as an alternative to fluconazole. Continue suppressive therapy for lifelong. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Adolescents

    200 to 400 mg PO every 12 hours as an alternative to fluconazole. Continue suppressive therapy for lifelong. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    For the treatment of meningitis due to Histoplasma capsulatum† in persons living with HIV.
    Oral dosage
    Adults

    400 mg PO every 12 hours for 1 day, then 200 mg PO every 12 hours for at least 12 months and until resolution of abnormal CSF findings in patients who are intolerant to itraconazole after induction therapy with liposomal amphotericin B. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[34362]

    Adolescents

    400 mg PO every 12 hours for 1 day, then 200 mg PO every 12 hours for at least 12 months and until resolution of abnormal CSF findings in patients who are intolerant to itraconazole after induction therapy with liposomal amphotericin B. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[34362]

    For the treatment of esophageal candidiasis.
    Intravenous dosage
    Adults†

    200 mg IV every 12 hours for 14 to 21 days is recommended by guidelines for patients with fluconazole-refractory disease.[34362] [60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Adolescents 15 to 17 years†

    200 mg IV every 12 hours for 14 to 21 days is recommended by guidelines for patients with fluconazole-refractory disease.[34362] [60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Children and Adolescents 12 to 14 years weighing 50 kg or more†

    200 mg IV every 12 hours for 14 to 21 days is recommended by guidelines for patients with fluconazole-refractory disease.[34361] [34362] [60487] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    4 mg/kg/dose IV every 12 hours for at least 14 days and for at least 7 days after symptom resolution. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34361] [34362] [60487]

    Children 2 to 11 years

    4 mg/kg/dose IV every 12 hours for at least 14 days and for at least 7 days after symptom resolution. May increase dose in 1 mg/kg increments for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34361] [34362] [60487]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years is not well established. 9 mg/kg/dose IV every 12 hours on day 1, followed by 8 mg/kg/dose IV every 12 hours is recommended by guidelines. This dose has been shown to provide comparable exposure in children 2 to 11 years to adults receiving 6 mg/kg/dose IV every 12 hours on day 1, followed by 4 mg/kg/dose IV every 12 hours.[34361] [54736] [60487] A maintenance dose of 4 mg/kg/dose every 12 hours in children provided comparable exposure to that seen in adults receiving 3 mg/kg/dose every 12 hours.[32393] [54736] However, it is unknown if this dosing strategy will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years.[54753] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations.[54742] [54743] [54744] [54745] [54747] [54755] Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34361] [34362] [60487]

    Oral dosage
    Adults weighing 40 kg or more

    200 mg PO every 12 hours for at least 14 days and for at least 7 days after symptom resolution. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours.[28158] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34362] [60487]

    Adults weighing less than 40 kg

    100 mg PO every 12 hours for at least 14 days and for at least 7 days after symptom resolution. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours.[28158] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34362] [60487]

    Adolescents 15 to 17 years weighing 40 kg or more

    200 mg PO every 12 hours for at least 14 days and for at least 7 days after symptom resolution. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours.[28158] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34362] [60487]

    Adolescents 15 to 17 years weighing less than 40 kg

    100 mg PO every 12 hours for at least 14 days and for at least 7 days after symptom resolution. Increase to 150 mg PO every 12 hours for inadequate response; if not tolerated, reduce dose to minimum 100 mg PO every 12 hours.[28158] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34362] [60487]

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    200 mg PO every 12 hours for at least 14 days and for at least 7 days after symptom resolution. Increase to 300 mg PO every 12 hours for inadequate response; if not tolerated, taper by 50 mg increments to minimum 200 mg PO every 12 hours.[28158] Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34361] [34362] [60487]

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) for at least 14 days and for at least 7 days after symptom resolution. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.[54736] [54776] Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34361] [60487]

    Children 2 to 11 years

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) for at least 14 days and for at least 7 days after symptom resolution. May increase dose in 1 mg/kg or 50 mg increments up to the maximum dose for inadequate response if initial dose is tolerated; if initial dose is not tolerated, reduce dose by 1 mg/kg or 50 mg increments. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions.[28158] Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.[34361] [60487]

    Infants† and Children younger than 2 years†

    Optimal dosing in infants and children younger than 2 years not well established. 9 mg/kg/dose PO every 12 hours is recommended by clinical practice guidelines and this dose has been shown to provide comparable exposure in children 2 to 11 years as adults receiving 200 mg PO every 12 hours. However, it is unknown if this dose will be adequate in younger children as pharmacokinetic data are limited. In a study of 30 children (1 month and older) receiving IV or oral voriconazole, the median dose necessary to achieve therapeutic concentrations was 38 mg/kg/day in children younger than 5 years. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Significant interpatient pharmacokinetic variability exists in children, particularly in children younger than 3 years and with oral administration, and measuring voriconazole serum concentrations is essential to aid in dosage adjustments. Many children require much higher doses to achieve therapeutic concentrations. Guidelines recommend voriconazole for 14 to 21 days as an alternative treatment for fluconazole-refractory disease.

    For the treatment of cardiovascular system infections, including endocarditis, myocarditis, pericarditis, and infected pacemaker, implantable cardiac defibrillator (ICD), or ventricular assist devices (VAD).
    For the treatment of Candida cardiovascular system infections†.
    Oral dosage
    Adults

    200 to 300 mg PO every 12 hours as alternative step-down therapy to fluconazole for susceptible isolates. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. For endocarditis, treat for at least 6 weeks after valve replacement. For infected cardiac hardware, treat for at least 4 to 6 weeks after hardware removal.

    Adolescents 15 to 17 years

    200 to 300 mg PO every 12 hours as alternative step-down therapy to fluconazole for susceptible isolates. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. For endocarditis, treat for at least 6 weeks after valve replacement. For infected cardiac hardware, treat for at least 4 to 6 weeks after hardware removal.

    Children and Adolescents 12 to 14 years weighing 50 kg or more

    200 to 300 mg PO every 12 hours as alternative step-down therapy to fluconazole for susceptible isolates. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. For endocarditis, treat for at least 6 weeks after valve replacement. For infected cardiac hardware, treat for at least 4 to 6 weeks after hardware removal.

    Children and Adolescents 12 to 14 years weighing less than 50 kg

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) as alternative step-down therapy to fluconazole for susceptible isolates. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. For endocarditis, treat for at least 6 weeks after valve replacement. For infected cardiac hardware, treat for at least 4 to 6 weeks after hardware removal. Higher doses, such as those recommended in children 2 to 11 years, are recommended in this population, as some pharmacokinetic data have shown a lower exposure in younger adolescents (12 to 14 years) with low body weight (less than 50 kg) when given the recommended adult doses.

    Children 2 to 11 years

    9 mg/kg/dose PO every 12 hours (Max: 350 mg/dose) as alternative step-down therapy to fluconazole for susceptible isolates. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. For endocarditis, treat for at least 6 weeks after valve replacement. For infected cardiac hardware, treat for at least 4 to 6 weeks after hardware removal.

    Infants and Children younger than 2 years

    Optimal dosing in infants and c