Anti-infective Agents : Antifungal Agents
OVFEN1 “Vfend FC tablet” 200 mg/tab
適應症：一、治療侵犯性麴菌症(invasive aspergillosis)、二、治療嚴重之侵犯性念珠菌感染(Serious invasive Candida infections)、三、治療足分枝菌(Scedosporium spp.)和鐮刀菌(Fusarium spp.)之嚴重黴菌感染、四、預防高危險患者發生侵入性黴菌感染，包括接受造血幹細胞移植 (HSCT)的患者。
Usual dose:
Allergic bronchopulmonary aspergillosis:
Salvage therapy, 200 mg PO BID.
Aspergillosis, Invasive:
initial, loading dose 6 mg/kg IV BID for 2 doses.
maintenance, 4 mg/kg IV (preferred route) or 200 mg PO BID for a minimum of 6 to 12 weeks; or 4 mg/kg IV BIDfor at least 7 days; continue maintenance with 4 mg/kg IV BID or 200 mg PO BID for patients weighing 40 kg or more or 100 mg PO BID for patients less than 40 kg.
(HIV infection) maintenance, 4 mg/kg IV BID or 200 mg PO BID continued at least until the peripheral CD4+ count is more than 200 cells/mcL and clinical response is evident.
Blastomycosis:
(CNS disease) step-down therapy (after initial treatment with a lipid formulation amphotericin B), 200 to 400 mg PO BID for at least 1 year and until resolution of cerebrospinal fluid abnormalities.
Candida endophthalmitis:
Alternative therapy, loading dose, 6 mg/kg IV or PO BID for 2 doses, followed by 3 to 4 mg/kg IV or PO BID for at least 4 to 6 weeks.
Candidemia
initial, loading dose 6 mg/kg IV BID for 2 doses, or 400 mg (6 mg/kg) IV/PO BID for 2 doses.
maintenance, 3 to 4 mg/kg IV BID; or 200 mg PO BID for patients weighing 40 kg or more; or 100 mg PO BID for patients less than 40 kg; treat for a minimum of 14 days following symptom resolution or following last positive culture, whichever is longer; or 200 mg (3 mg/kg) IV/PO BID for 2 weeks after clearance of candidemia from bloodstream and resolution of symptoms.
Candidiasis of the esophagus
200 mg PO BID for patients weighing 40 kg or more; OR 100 mg PO BID for patients less than 40 kg; treat for a minimum of 14 days and for at least 7 days after resolution of symptoms
(HIV infection) initial episodes, 200 mg IV/PO BID for 14 to 21 days.
(fluconazole-refractory disease) 200 mg PO BID for 14 to 21 days.
Contraindications
Concomitant use of carbamazepine, CYP3A4 substrates (terfenadine, astemizole, cisapride, pimozide, or quinidine), high-dose ritonavir (400 mg every 12 hours), ergot alkaloids, long-acting barbiturates, rifabutin, rifampin, sirolimus, or St John’s wort.
Concomitant use with efavirenz at standard doses of 400 mg/day or higher.
Hypersensitivity to voriconazole or any product component
Adverse Effects
Common: peripheral edema, rash, diarrhea, nausea, vomiting, headache, visual disturbance, hallucinations, fever.
Serious: cardiac arrest, cardiac dysrhythmia, prolonged qt interval, sudden cardiac death, torsades de pointes, erythema multiforme, malignant melanoma, squamous cell carcinoma, stevens-johnson syndrome, toxic epidermal necrolysis, pancreatitis, cholestasis, fulminant hepatic failure, hepatitis, hyperbilirubinemia, increased bilirubin level, increased liver function test, jaundice, liver function tests abnormal, anaphylactoid reaction, toxic encephalopathy, optic disc edema, optic neuritis,renal failure, malignant melanoma, squamous cell carcinoma.