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Antifungal — Invasive Aspergillosis

Voriconazole

Brand names: VFEND

Voriconazole is a broad-spectrum triazole antifungal used for invasive aspergillosis and other serious mould and yeast infections, including in respiratory disease. It is available as oral and intravenous formulations and is typically managed by specialists.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits the fungal cytochrome P450 enzyme 14-alpha-demethylase, blocking ergosterol synthesis and disrupting the fungal cell membrane.

Prescribing in practice

  • Voriconazole is a potent CYP enzyme inhibitor with numerous serious and contraindicated drug interactions, so concurrent medicines must be screened carefully before and during treatment.
  • It commonly causes reversible visual disturbances and is associated with hepatotoxicity, QT prolongation and, with prolonged use, photosensitivity and skin-cancer risk requiring sun protection.
  • Therapeutic drug monitoring of plasma concentrations is advised to optimise efficacy and limit toxicity given variable metabolism.

Monitoring

Monitor liver function, visual symptoms, electrolytes and ECG where relevant, plus plasma trough concentrations through therapeutic drug monitoring.

Counselling the patient

  • Transient visual changes can occur, so avoid driving at night if affected, and report persistent visual or eye symptoms.
  • Protect your skin from sunlight and report yellowing of the skin or eyes.

Evidence & guidelines

Voriconazole is supported by trial evidence establishing it as first-line therapy for invasive aspergillosis in UK and international antifungal guidance.

Reference: Herbrecht et al. NEJM 2002 (voriconazole vs amphotericin B in IA); ESCMID/ECMM/ERS Aspergillosis Guidelines 2018; NICE; SPC VFEND; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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