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Voriconazole or VFEND

is a triazole antifungal medication that is generally used to treat serious, invasive fungal infections. These are generally seen in patients who are immunocompromised, those who have had a transplant and those who have various cancers and are undergoing chemotherapy.  It is used against invasive candidiasis, invasive aspergillosis, and certain’ emerging fungal infections’. The emerging fungal infections include

• Fusarium spp
• and Scedosporium apiospermum

It is, interestingly enough, also being used to treat patients with ‘ unresolved fever despite broad-spectrum antibiotic therapy who are at risk for breakthrough fungal infections’

And

‘While overall success rates were 26.0% for voriconazole and 30.6% for liposomal amphotericin B, there were significantly fewer breakthrough infections with voriconazole, particularly in the patients at highest risk. This study found similar fewer severe reactions and nephrotoxicity but more transient visual disturbances and hallucinations’.

Voriconazole is used intravenously and via oral administration.

Side effects

The most common side effects associated with voriconazole include transient visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache, sepsis, peripheral edema, abdominal pain, and respiratory disorder.

Unlike most adverse effects, which are similar to other azole antifungal agents, visual disturbances (such as blurred vision or increased sensitivity to light) are ‘common’ to voriconazole. These have been reported by more than 30% of patients in clinical trials. They generally occur approximately one-half hour after administration, and last approximately 30 minutes. “patients taking voriconazole should be advised against driving at night or other potentially hazardous tasks”.

•  Drug interactions - Being metabolized by hepatic cytochrome P450, voriconazole interacts with some drugs.

• Liver damage -  there have been cases of serious hepatic reactions during treatment with voriconazole (a class effect of azole antifungal agents). Liver function tests should be evaluated at the start of and during the course of therapy.

• Cancer - Voriconazole is phototoxic. It has been associated with an increased risk of squamous-cell carcinoma of the skin.