Triazole derivatives, systemic antifungals
ATC code: J02AC03 (Voriconazole)
Brand names
Vfend, Voriconazol Accord, Voriconazol Sandoz, Voriconazol Normon
Second-generation systemic triazole antifungal. Inhibits fungal lanosterol-14-alpha-demethylase (CYP51), blocking ergosterol synthesis – a key fungal membrane component. Active against Aspergillus spp., Candida (including fluconazole-resistant C. krusei and C. glabrata), Scedosporium, Fusarium. Oral bioavailability 96% – oral and IV forms are interchangeable. Metabolized by CYP2C19, CYP2C9, CYP3A4 – high inter-patient variability requires therapeutic drug monitoring (TDM).
First line
First-line for invasive aspergillosis per 2024 and Spanish SEIMC 2023 (Herbrecht NEJM 2002 showed superiority over amphotericin B). Adult dose: loading 6 mg/kg IV twice daily on day 1, then maintenance 4 mg/kg IV twice daily or 200 mg orally twice daily. Duration – minimum 6-12 weeks depending on clinical response and immune status. Target trough concentration (TDM) 1-5.5 mcg/mL. Alternatives – isavuconazole, liposomal amphotericin B.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Voriconazole is a broad-spectrum triazole antifungal. It is prescribed for invasive aspergillosis and other severe invasive mycoses in immunocompromised patients ( 2024). Voriconazole is occasionally prescribed for prophylaxis in immunocompetent adults without confirmed invasive aspergillosis or severe mycoses. In immunocompetent people without a confirmed invasive mycosis diagnosis, no clinical studies of prophylactic use exist, and the risks are not justified. The drug has serious risks: hepatotoxicity, QT prolongation, photosensitivity with risk of cutaneous squamous cell carcinoma on long-term use, visual disturbances (visual hallucinations, color perception disturbances), and drug interactions. If voriconazole was prescribed without confirmed invasive mycosis, consider seeking a second opinion.
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Teratogenic (cleft palate, skeletal abnormalities in animal studies). Used only in life-threatening mycoses when benefit outweighs risk. Barrier contraception mandatory during and 1 month after therapy.
No milk excretion data. If therapy is required, temporarily discontinue breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Voriconazole is evaluated for the following indications with varying evidence strength: Invasive aspergillosis (evidence tier A), Immune support and respiratory infection care (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Voriconazole (≥ 1 in 100): Visual disturbances (altered color vision, photophobia) in 30-45%, Nausea, Vomiting, Rash, Fever, ALT/AST elevation. See the Safety section for uncommon and serious reactions.
FDA category D. Teratogenic (cleft palate, skeletal abnormalities in animal studies). Used only in life-threatening mycoses when benefit outweighs risk. Barrier contraception mandatory during and 1 month after therapy.
No milk excretion data. If therapy is required, temporarily discontinue breastfeeding.
Voriconazole is contraindicated in: Hypersensitivity; Pregnancy (teratogenic); Combination with specified CYP inducers and inhibitors; Combination with QT-prolonging CYP3A4 substrates (quinidine, pimozide); Severe hepatic impairment. Full list in the Safety section.