Voriconazole

What is this medication for?

Voriconazole is an anti-fungal medication which works by interfering with the growth of fungi. It is used to treat fungal infection and may also be used to prevent fungal infection in patients after transplant or in patients with weak immunity.

How should I take or use this medication?

• Do not stop taking your medication unless instructed by your healthcare professional (e.g. doctor, pharmacist).
• Voriconazole tablet should be taken on an empty stomach at least one hour before meal, or one hour after meal. Swallow the tablet whole with water.
• Voriconazole oral suspension should be taken at least one hour before, or two hours after food. Follow the instructions below to reconstitute the powder for oral suspension.

Preparing for reconstitution
	Remove the medication from the packaging.
To reconstitute the powder for oral suspension
	Step 1: Tap the bottle to loosen the powder.
	Step 2: A total of 46 mL of cool, boiled water should be added to the bottle: measure 23 mL of water by filling the measuring cup to the top of the marked line. Add the water to the bottle. Measure another 23 mL of water using the measuring cup and add this to the bottle.
	Step 3: Replace the cap and shake the closed bottle vigorously for about 1 minute.
	Step 4: Remove child-resistant cap. Press the bottle adaptor into the neck of the bottle.
	Step 5: Replace the cap.
	Step 6: Write the date of expiration of the reconstituted suspension on the bottle label (the shelf-life of the reconstituted suspension is 14 days).
To administer the reconstituted oral suspension (only use the oral syringe supplied with each pack)
	Step 1: Shake the closed bottle of the reconstituted suspension for approximately 10 seconds before each use. Remove the cap.
	Step 2: While the bottle is upright, on a flat surface, insert the tip of the oral syringe into the adaptor.
	Step 3: Turn the bottle upside down while holding the oral syringe in place. Slowly pull back the plunger of the oral syringe to the graduation mark that marks the dose for you. To measure the dose accurately, the top edge of the black ring should be lined up with the graduated mark on the oral syringe.
	Step 4: If large bubbles can be seen, slowly push the plunger back into the syringe. This will force the medicine back into the bottle. Repeat step 3.
	Step 5: Turn the bottle back upright with the oral syringe still in place. Remove the oral syringe from the bottle.
	Step 6: Put the tip of the oral syringe into the mouth. Point the tip of the oral syringe towards the inside of the cheek. SLOWLY push down the plunger of the oral syringe. Do not squirt the medicine out quickly.
	Step 7: Replace the cap on the bottle, leaving the bottle adaptor in place.
	Step 8: The syringe should be washed after each dose. Pull the plunger out of the syringe and wash both parts in warm soapy water. Then rinse with water. Dry the two parts. Push the plunger back into the syringe.
	Step 9: Keep it in a clean, safe place with the medicine.

What should I do if I forget to take or use this medication?

If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, take your next dose at the usual time. Do not take two doses to make up for the missed dose.

What precautions should I take when taking or using this medication?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
• You are pregnant, planning to become pregnant, or breastfeeding.
  • Voriconazole may cause harm to an unborn child. Effective contraceptives must be used in women of child bearing potential.
  • It is not known if voriconazole is excreted into breast milk. Due to possible risks to the baby, please discuss with your doctor if you intend to breastfeed.
• You are taking any other medications, including supplements, traditional medications and herbal remedies, as there may be a possibility of drug interactions.

What are some common side effects of this medication? ​

• Nausea, vomiting or diarrhoea
  • Increase fluids and electrolytes intake as tolerated (unless you have specific fluid restriction instructed by your doctor).
• Headache and muscle pain
  • You may take painkillers e.g. paracetamol (Panadol) if the pain is mild.
• Visual disturbances e.g. blurred vision, changes to colour perception, intolerance to light. This is reversible and is usually transiently associated with higher levels of the medication.
  • Avoid driving or operating machinery.
• Difficulty in sleeping, confusion and hallucination e.g. seeing and/or hearing things that are not present, abnormal dreams.
• Heart rhythm problems e.g. very fast heartbeat, very slow heartbeat, dizziness, fainting.

If you experience any of these symptoms, or if the symptoms persist or get worse, please inform your doctor.

What are some rare but serious side-effects that I need to seek medical advice immediately? 

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Some of these serious side effects include:

• Liver problems: signs include dark urine, light-coloured stools, yellowing of the whites of your eyes or skin (jaundice). Severe nausea, vomiting and loss of appetite may also be experienced in severe liver problems.
• Pancreas problems: signs include severe abdominal pain or back pain, severe nausea, vomiting, loss of appetite.

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

What food or medication should I avoid when I take or use this medication?

Voriconazole can have interaction when taken with other medications. These include:

• Blood thinners (e.g. warfarin, apixaban, rivaroxaban)
• Tuberculosis medications (e.g. rifampicin, rifabutin)
• Anti-virals to treat human immunodeficiency virus (HIV) infection (e.g. efavirenz, nevirapine, atazanavir, ritonavir)
• Seizures medications (e.g. phenytoin, carbamazepine)
• Immunosuppressants (e.g. ciclosporin, tacrolimus)
• Cholesterol lowering medications (e.g. simvastatin, atorvastatin, lovastatin)
• Gastric medications (e.g. omeprazole)
• Chemotherapy agents (e.g. vinca alkaloids)
• Migraine medications (e.g. ergotamine)
• Herbal medicine (e.g. St John’s wort)

However, this list of medications is non-exhaustive. Hence, please inform your doctor/pharmacist of all medications including over-the counter (OTC) medications that you are taking prior to starting Voriconazole and any new medications while on Voriconazole treatment.

How should I store this medication?

• For oral tablet: Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.
• For oral suspension:
  • Before reconstitution: Store at 2°C-8°C (in a refrigerator)
  • After reconstitution: Store at room temperature, at a cool dry place. Do not refrigerate or freeze.
  • Discard any remaining suspension 14 days after reconstitution.

How do I throw away this medication safely? ​

For oral tablet: Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.

For oral suspension: Pack the empty bottles into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. If there is any balance medication, pack the medication into a bag and bring it back to the pharmacy where you received the medication from.