DRUG	SUPPLIED	DOSE	COMMENTS
VORICONAZOLE (Paeds) (VFend) Mechanism of action: Triazole antifungal Ref: 6, 44, 93, 180, 181, 270, 612, 632, 633 Last update: 2023-04-17	tablet: 50 mg, 200 mg injection: 200 mg vials	Infants and children < 2 yrs IV/PO: 9 mg/kg/dose Q12H Children 2 to < 12 yrs Initial: 9 mg/kg/dose IV Q12H x 2 doses Maintenance: IV: 8 mg/kg/dose Q12H PO: 9 mg/kg/dose Q12H. Max 350 mg/dose Children 12-14 yrs who are <50 kg Initial: 9 mg/kg/dose IV Q12H x 2 doses Maintenance: IV: 8 mg/kg/dose Q12H PO: 9 mg/kg/dose (Max 350 mg/dose) Children 12-14 yrs who are >= 50 kg and adolescents >= 15 yrs Initial: 6 mg/kg/dose IV Q12H x 2 doses Maintenance: IV: 4 mg/kg/dose Q12H PO: 200-300 mg Q12H	Bioavailability 80% > 90%. Indicated as first line agent for invasive fungal infections by Aspergillus spp. Multiple, serious/life-threatening drug interactions involving the cytochrome P450 enzymes; check with pharmacy before initiating or stopping voriconazole therapy. Avoid use of IV formulation in renal impairment due to accumulation of the IV solution vehicle. Adjust dose in hepatic impairment. Transient, dose-related visual disturbances occur in up to 45% of patients on voriconazole. This effect is most common in the first week of therapy and is reversible after patient becomes tolerant of voriconazole or after it is discontinued. Serious hepatic reactions and increase in liver function tests have been reported. Anaphylactoid type reaction may occur on initiation of IV infusion. Other ADR include skin rash, photosensitivity, cardiac arrhythmias, agranulocytosis and GI problems. Draw voriconazole serum trough concentrations on Tuesdays (levels are processed every Thursday morning at St. Paul’s Hospital). Target trough concentrations: 1 to 5.5 mg/L. Steady-state concentrations require at least four days after onset of treatment or change in dose. Standard Prescription: voriconazole__mg PO{IV} Q__H (__mg/kg/dose)