Voriconazole (patient information)

# Why is this medication prescribed
Voriconazole is used to treat serious fungal infections such as invasive aspergillosis (a fungal infection that begins in the lungs and spreads through the bloodstream to other organs) and esophageal candidiasis (infection by a yeast-like fungus that may cause white patching in the mouth and throat). Voriconazole is in a class of antifungal medications called triazoles. It works by slowing the growth of the fungi that cause infection.

# How should this medicine be used
Voriconazole comes as a tablet and a suspension (liquid) to take by mouth. It is usually taken every 12 hours on an empty stomach, at least 1 hour before or 1 hour after a meal. To help you remember to take voriconazole, take it at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take voriconazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
If you are taking voriconazole suspension, shake the closed bottle for about 10 seconds before each use to mix the medication evenly. Do not mix the suspension with any other medications, water, or any other liquid. Always use the measuring device that comes with your medication. You may not get the right amount of medication if you use a household spoon to measure your dose.
At the beginning of your treatment, you may receive voriconazole by intravenous (into a vein) injection. When you begin taking voriconazole by mouth, your doctor may start you on a low dose and increase your dose if your condition does not improve. Your doctor also may decrease your dose if you experience side effects from voriconazole.
The length of your treatment depends on your general health, the type of infection you have, and how well you respond to the medication. If you are taking voriconazole for esophageal candidiasis, you will take it for at least 14 days. If you are taking voriconazole for aspergillosis, you may take it for several months or longer. Continue to take voriconazole even if you feel well. Do not stop taking voriconazole without talking to your doctor.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow?
Before taking voriconazole
- tell your doctor and pharmacist if you are allergic to voriconazole; other antifungal medications such as fluconazole (Diflucan), itraconazole (Sporonox), or ketoconazole (Nizoral); or any other medications.
- do not take voriconazole if you are taking any of the following medications: astemizole (Hismanal) (not available in the United States); carbamazepine (Tegretol); cisapride (Propulsid); efavirenz (Sustiva); ergot-type medications such as dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Germinal, Hydergine), ergonovine (Ergotrate), ergotamine (Bellergal-S, Cafergot, Ergomar, Wigraine), methylergonovine (Methergine), and methysergide (Sansert); phenobarbital (Luminal, Solfoton); pimozide (Orap); quinidine (Quinadex, Quinaglute); mephobarbital (Mebaral); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); ritonavir (Norvir, in Kaletra); sirolimus (Rapamune); and terfenadine (Seldane) (not available in the United States).
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: amiodarone (Cordarone); anticoagulants ('blood thinners') such as warfarin (Coumadin); benzodiazepines such as alprazolam (Xanax), diazepam (Valium), midazolam (Versed), and triazolam (Halcion); calcium channel blockers such as amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop), and nisoldipine (Sular); cholesterol-lowering medications (statins) such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor); cyclosporine (Neoral, Sandimmune); disopyramide (Norpace); dofetilide (Tikosyn); erythromycin (E.E.S., E-Mycin, Erythrocin); medications for diabetes such as glipizide (Glucotrol), glyburide (Diabeta, Micronase, Glycron, others), and tolbutamide (Orinase); medications for HIV such as amprenavir (Agenerase), atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), nelfinavir (Viracept), nevirapine (Viramune), and saquinavir (Fortovase, Invirase); methadone (Dolophine); moxifloxacin (Avelox); phenytoin (Dilantin); procainamide (Procanbid, Pronestyl); proton-pump inhibitors such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (AcipHex); sotalol (Betapace); sparfloxacin (Zagam); tacrolimus (Prograf); thioridazine (Mellaril); vinblastine;and vincristine (Vincasar). Many other medications may also interact with voriconazole, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John's wort.
- tell your doctor if you have ever been treated with chemotherapy medications for cancer and if you have or have ever had cardiomyopathy (enlarged or thickened heart muscle that stops the heart from pumping blood normally), cancer of the blood cells, any condition that makes it difficult for you to digest sucrose or lactose, or liver or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking voriconazole, call your doctor.
- you should know that voriconazole may cause blurred vision or other problems with your eyesight and may make your eyes sensitive to bright light. Do not drive a car at night while taking voriconazole. Do not drive a car during the day or operate machinery if you have any problems with your vision while you are taking this medication.
plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Voriconazole may make your skin sensitive to sunlight.

# What special dietary instructions should I follow
Talk to your doctor about drinking grapefruit juice while taking this medicine.

# What should I do if I forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side Effects

## Mild side effects
Voriconazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- blurred or abnormal vision
- difficulty seeing colors
- sensitivity to bright light
- diarrhea
- vomiting
- headache
- dizziness
- dry mouth
- flushing

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- fever
- chills or shaking
- fast heartbeat
- fast breathing
- confusion
- upset stomach
- extreme tiredness
- unusual bruising or bleeding
- lack of energy
- loss of appetite
- pain in the upper right part of the stomach
- yellowing of the skin or eyes
- flu-like symptoms
- hallucinations (seeing things or hearing voices that do not exist)
- chest pain
- rash
- hives
- itching
- difficulty breathing or swallowing
- swelling of the hands, feet, ankles, or lower legs
Voriconazole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not refrigerate or freeze the medication. Throw away any medication that is outdated or no longer needed. Throw away any unused suspension after 14 days. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- sensitivity to light
- widened pupils (black circles in the middle of the eyes)
- closed eyes
- drooling
- loss of balance while moving
- depression
- shortness of breath
- seizures
- swollen stomach
- extreme tiredness

# What other information should I know
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to voriconazole.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. If you still have symptoms of infection after you finish the voriconazole, call your doctor.

# Brand names
- Vfend