lSIDE-EFFECTS
▶Common or very commonAcute kidney injury.
agranulocytosis.alopecia.anaemia.anxiety.arrhythmias
.asthenia.bone marrow disorders.chest pain.chills.
confusion.constipation.depression.diarrhoea.dizziness
.drowsiness.dyspnoea.electrolyte imbalance.eye
disorders.eye inflammation.fever.gastrointestinal
discomfort.haemorrhage.hallucination.headache.
hepatic disorders.hypoglycaemia.hypotension.
increased risk of infection.insomnia.leucopenia.muscle
tone increased.nausea.neutropenia.oedema.oral
disorders.pain.pulmonary oedema.respiratory disorders
.seizure.sensation abnormal.skin reactions.syncope.
tetany.thrombocytopenia.tremor.vision disorders.
vomiting
▶UncommonAdrenal insufficiency.arthritis.brain oedema
.duodenitis.encephalopathy.eosinophilia.gallbladder
disorders.hearing impairment.hypothyroidism.
influenza like illness.lymphadenopathy.lymphangitis.
movement disorders.nephritis.nerve disorders.
pancreatitis.parkinsonism.phototoxicity.proteinuria.
pseudomembranous enterocolitis.QT interval
prolongation.renal tubular necrosis.severe cutaneous
adverse reactions (SCARs).taste altered.
thrombophlebitis.vertigo
▶Rare or very rareAngioedema.cardiac conduction
disorders.disseminated intravascular coagulation.
hyperthyroidism
▶Frequency not knownCutaneous lupus erythematosus.
infusion related reaction.periostitis (more common in
transplant patients).squamous cell carcinoma (more
common in presence of phototoxicity)
SIDE-EFFECTS, FURTHER INFORMATION
HepatotoxicityHepatitis, cholestasis, and acute hepatic
failure have been reported; risk of hepatotoxicity increased
in patients with haematological malignancy. Consider
treatment discontinuation if severe abnormalities in liver
function tests.
PhototoxicityPhototoxicity occurs uncommonly. If
phototoxicity occurs, consider treatment discontinuation;
if treatment is continued, monitor for pre-malignant skin
lesions and squamous cell carcinoma, and discontinue
treatment if they occur.
lCONCEPTION AND CONTRACEPTIONEffective
contraception required during treatment.
lPREGNANCYToxicity inanimalstudies—manufacturer
advises avoid unless potential benefit outweighs risk.
lBREAST FEEDINGManufacturer advises avoid—no
information available.
lHEPATIC IMPAIRMENT
Dose adjustments▶Child 12–17 yearsIn mild to moderate
hepatic cirrhosis use usual initial dose then halve
subsequent doses. No information available for severe
hepatic cirrhosis—manufacturer advises use only if
potential benefit outweighs risk.
lRENAL IMPAIRMENT
▶Child 2-12 yearsNo information available.
▶Child 12-17 yearsIntravenous vehicle may accumulate if
estimated glomerularfiltration rate less than
50 mL/minute/ 1. 73 m^2 —use intravenous infusion only if
potential benefit outweighs risk, and monitor renal
function; alternatively, use tablets or oral suspension (no
dose adjustment required).
lMONITORING REQUIREMENTS
▶Monitor renal function.
▶Monitor liver function before starting treatment, then at
least weekly for 1 month, and then monthly during
treatment.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, reconstitute each 200 mg with 19 mL Water for
InjectionsorSodium Chloride 0. 9 % to produce a 10 mg/mLsolution; dilute dose to concentration of 0. 5 – 5 mg/mL
with Glucose 5 % or Sodium Chloride 0. 9 % and give
intermittently at a rate not exceeding 3 mg/kg/hour.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral liquid formulations may include orange.
lPATIENT AND CARER ADVICEPatients and their carers
should be told how to recognise symptoms of liver
disorder, and advised to seek immediate medical attention
if symptoms such as persistent nausea, vomiting, malaise
or jaundice develop.
Patients and their carers should be advised that patients
should avoid intense or prolonged exposure to direct
sunlight, and to avoid the use of sunbeds. In sunlight,
patients should cover sun-exposed areas of skin and use a
sunscreen with a high sun protection factor. Patients
should seek medical attention if they experience sunburn
or a severe skin reaction following exposure to light or sun.
Patients and their carers should be advised to keep the
alert card with them at all times.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS9, 11, 23
▶Voriconazole (Non-proprietary)
Voriconazole 50 mgVoriconazole 50 mg tablets| 28 tabletP
£ 45. 43 – £ 275. 68 DT = £ 193. 58
Voriconazole 200 mgVoriconazole 200 mg tablets| 28 tabletP
£ 157. 49 – £ 1 , 102. 74 DT = £ 766. 96
▶VFEND(Pfizer Ltd)
Voriconazole 50 mgVFEND 50 mg tablets| 28 tabletP£ 275. 68
DT = £ 193. 58
Voriconazole 200 mgVFEND 200 mg tablets| 28 tabletP
£ 1 , 102. 74 DT = £ 766. 96
Oral suspension
CAUTIONARY AND ADVISORY LABELS9, 11, 23
▶VFEND(Pfizer Ltd)
Voriconazole 40 mg per 1 mlVFEND 40 mg/ml oral suspension|
75 mlP£ 551. 37
Powder for solution for infusion
EXCIPIENTS:May contain Sulfobutylether beta cyclodextrin sodium
ELECTROLYTES:May contain Sodium
▶Voriconazole (Non-proprietary)
Voriconazole 200 mgVoriconazole 200 mg powder for solution for
infusion vials| 1 vialP£ 51. 43 – £ 77. 14 (Hospital only)
▶VFEND(Pfizer Ltd)
Voriconazole 200 mgVFEND 200 mg powder for solution for infusion
vials| 1 vialP£ 77. 14 (Hospital only)
Powder and solvent for solution for infusion
EXCIPIENTS:May contain Sulfobutylether beta cyclodextrin sodium
ELECTROLYTES:May contain Sodium
▶VFEND(Pfizer Ltd)
Voriconazole 200 mgVFEND 200 mg powder and solvent for solution
for infusion vials| 1 vialP£ 77. 14 (Hospital only)ANTIFUNGALS›OTHER
Flucytosine
lINDICATIONS AND DOSE
Systemic yeast and fungal infections|Adjunct to
amphotericin in severe systemic candidiasis and in other
severe or long-standing infections
▶BY INTRAVENOUS INFUSION, OR BY MOUTH
▶Neonate: 50 mg/kg every 12 hours.▶Child:Usual dose 50 mg/kg every 6 hours usually for
not more than 7 days, alternatively 25 – 37. 5 mg/kg
every 6 hours usually for not more than 7 days, lower
dose may be sufficient for sensitive organisms378 Fungal infection BNFC 2018 – 2019
Infection5