Voriconazole Dosing Guidelines

Standard Dosing Regimen

• The Infectious Diseases Society of America recommends initiating voriconazole with a loading dose of 6 mg/kg IV every 12 hours for two doses, followed by a maintenance dose of 4 mg/kg IV every 12 hours, which can be switched to 200 mg oral every 12 hours once the patient is clinically stable 1
• The standard loading dose is 6 mg/kg IV every 12 hours for the first 24 hours, with a maintenance dose of 3-4 mg/kg IV every 12 hours 2, 1, 3

Special Population Considerations

• The National Kidney Foundation notes that the IV formulation is contraindicated in patients with creatinine clearance <50 mL/min due to cyclodextrin accumulation, while the oral formulation requires no dosage adjustment for any degree of renal insufficiency 2, 3, 4
• The American Association for the Study of Liver Diseases recommends reducing the maintenance dose by 50% in patients with mild to moderate hepatic impairment 4

Duration of Therapy by Indication

• The Infectious Diseases Society of America recommends a median duration of 10 days IV followed by 76 days oral therapy for invasive aspergillosis, with a minimum of 6-12 weeks of treatment 1, 4
• The society also recommends treating candidemia and deep tissue candida infections for at least 14 days after documented clearance from bloodstream AND resolution of symptoms 5, 4

Critical Contraindications and Caveats

• The Infectious Diseases Society of America advises against using voriconazole for urinary candidiasis, as it does not accumulate in active form in urine 4
• The society recommends voriconazole as a preferred indication for CNS aspergillosis, step-down therapy for C. krusei and fluconazole-resistant, voriconazole-susceptible C. glabrata, Fusarium species infections, and Scedosporium apiospermum infections 4, 2, 3