Voriconazole
Pronunciation: pronunciation varies by local usage.
- Generic name
- voriconazole
- Brand names
- VFEND
- Drug class
- Triazole antifungal
- Form
- Oral tablet, oral suspension, and intravenous infusion
- Route
- Oral and intravenous
- Legal status
- Prescription-only medicine
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What voriconazole is and how it works
Voriconazole is a prescription triazole antifungal that works by inhibiting a fungal enzyme required for cell-membrane ergosterol synthesis. It is used for a range of serious invasive fungal infections in adults and in children aged 2 years and older. (1)
All facts in this article are drawn from the US FDA-approved prescribing information for voriconazole tablets (DailyMed). Approved uses, dosing, and product selection may differ by age, body weight, indication, liver function, kidney function, and country-specific labelling outside the United States, which has not been reviewed for this pass. The US label establishes risks including liver injury, visual disturbances, QT-prolongation risk, serious drug interactions, skin-cancer risk, and fetal harm.
Mechanism of action: how voriconazole works
Voriconazole is a triazole antifungal. Its primary mechanism of action is inhibition of fungal cytochrome P450-mediated 14-alpha-sterol demethylation, an essential step in fungal cell membrane ergosterol synthesis. (1)
What voriconazole is used for
Invasive aspergillosis
Voriconazole is indicated for treatment in adults and pediatric patients aged 2 years and older. (1)
Candidemia in non-neutropenic patients and disseminated Candida infections
Indicated for candidemia in non-neutropenic patients, and for the following deep tissue Candida infections: disseminated Candida infections of the skin and body. Adult and pediatric patients aged 2 years and older are covered. (1)
Esophageal candidiasis
Indicated in adults and pediatric patients aged 2 years and older. (1)
Serious fungal infections caused by Scedosporium apiospermum and Fusarium species
Indicated for serious infections caused by these moulds in adults and pediatric patients aged 2 years and older. (1)
Before taking voriconazole
Do not take / not appropriate for
- The following are contraindicated for co-administration with voriconazole because of the risk of serious or life-threatening reactions or loss of therapeutic effect: pimozide, quinidine, sirolimus, ivabradine, rifampin, carbamazepine, long-acting barbiturates, efavirenz at standard doses (400 mg once daily or higher), high-dose ritonavir (400 mg every 12 hours or higher), rifabutin, ergot alkaloids (e.g., ergotamine, dihydroergotamine), St. John's Wort, naloxegol, tolvaptan, lurasidone, or venetoclax during the CLL/SLL initiation and ramp-up phase. Tell the prescriber and pharmacist about all medicines you take. (all products) (1)
Tell your clinician about
- Any current or planned medicines, including every prescription, over-the-counter product, herb or supplement, because voriconazole has many serious drug interactions.
- Any history of liver problems, heart rhythm disorders (especially long QT syndrome), cardiomyopathy, or electrolyte imbalances (low potassium, magnesium, or calcium).
- If you are pregnant, planning pregnancy, or could become pregnant — voriconazole can cause fetal harm and effective contraception is essential during treatment.
- If you have risk factors for pancreatitis.
- If you are taking corticosteroids.
How to take voriconazole
- Voriconazole is given either by mouth (tablet or suspension) or by intravenous infusion, according to an indication-, age-, weight- and organ-function-specific schedule set by the specialist.
- For most indications, treatment begins with a loading dose for the first 24 hours followed by a maintenance dose; the specialist determines the exact regimen, which differs by indication (for example, esophageal candidiasis uses an oral-only regimen without the loading-dose schedule used for other indications).
- Do not alter the dose, route, or schedule yourself.
- Meal-timing instructions for the oral tablet and IV-to-oral dose-conversion detail were not established in the sources reviewed for this article; follow the specific instructions given by the prescriber or pharmacist.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
Missed-dose instructions were not established in the sources reviewed for this article. This remains an
Overdose
Overdose management details were not established in the sources reviewed for this article. This remains an
Side effects
Side effects can be serious. Liver function, and (for treatment beyond 28 days) vision, are monitored; sun-protection measures and dermatologic evaluation for new or changing skin lesions are advised. Many reported side effects were identified in clinical trials and postmarketing surveillance.
Visual disturbances
What to notice: Specific symptom detail was not established in the sources reviewed for this article beyond the general category of visual disturbances (reported in 18.7% of patients in trials). The effect on visual function beyond 28 days is not known.
What to do: Report changes to the prescriber promptly. If treatment continues beyond 28 days, visual function (including visual acuity, visual field, and color perception) should be monitored. (1)
Other common effects
What to notice: Fever, nausea, rash, vomiting, chills, headache, abnormal liver function tests, tachycardia, and hallucinations. These were reported at an incidence of 2% or greater in adult trials.
What to do: Discuss any persistent or troublesome symptoms with the prescribing team, who can advise whether treatment should continue or change. (1)
Hepatotoxicity
What to notice: Specific symptom detail was not established in the sources reviewed for this article; the sources support that serious hepatic reactions have occurred and are usually reversible on discontinuation.
What to do: Contact the prescriber immediately for assessment and liver function testing. (1)
Skin changes and phototoxicity
What to notice: New or changing skin lesions, or any lesion that looks like an early skin cancer (such as an actinic keratosis). Specific symptom detail beyond this was not established in the sources reviewed for this article.
What to do: Undergo dermatologic evaluation for any new or changing skin lesion. Premalignant skin lesions or squamous cell carcinoma can develop, particularly with long-term therapy. (1)
Adrenal dysfunction (when taken with corticosteroids)
What to notice: Specific symptom detail was not established in the sources reviewed for this article.
What to do: Report any symptoms of concern; monitoring for adrenal dysfunction is recommended both during and after voriconazole treatment in patients also receiving corticosteroids. (1)
Pancreatitis
What to notice: Specific symptom detail was not established in the sources reviewed for this article.
What to do: Seek medical assessment urgently for any symptoms of concern, especially if you already have risk factors for pancreatitis. (1)
Serious warnings
Hepatotoxicity — serious
Symptoms: Specific symptom detail was not established in the sources reviewed for this article; the sources support that serious hepatic reactions have occurred and are usually reversible on discontinuation.
Action: Seek medical attention promptly. Liver function must be evaluated at the start of treatment and monitored at least weekly for the first month. Serious hepatic reactions are usually reversible on discontinuation, but the decision to continue or stop must be made by the treating clinician based on test results and clinical assessment. (1)
QT prolongation and arrhythmia — serious
Symptoms: Specific symptom detail was not established in the sources reviewed for this article; the sources support that rare cases of arrhythmias (including torsade de pointes), QT prolongation, and sudden death have been reported.
Action: Obtain emergency assessment if these occur. The treating clinician should correct any potassium, magnesium, or calcium abnormalities before and during therapy. (1)
Visual disturbances and optic effects — serious
Symptoms: Persistent visual changes, optic neuritis, or papilledema; concerns increase after 28 days of treatment.
Action: Report any ongoing or new visual disturbance. Visual monitoring (acuity, field, color perception) is recommended if therapy extends beyond 28 days. (1)
Phototoxicity and skin malignancy — serious
Symptoms: Specific symptom detail was not established in the sources reviewed for this article; the sources support sun-sensitivity risk and that squamous cell carcinoma and melanoma have been reported during long-term therapy.
Action: Use strong sun protection (protective clothing, high-SPF sunscreen). Seek dermatologic evaluation for any new or changing skin lesion; the treating clinician will advise whether voriconazole should be continued or changed if a premalignant lesion or squamous cell carcinoma develops. (1)
Fetal harm — serious
Symptoms: Voriconazole can cause fetal harm; evaluate pregnancy status before treatment.
Action: Females of reproductive potential must use effective contraception during treatment. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Contraindicated co-administration list | Pimozide, quinidine, sirolimus, ivabradine, rifampin, carbamazepine, long-acting barbiturates, efavirenz 400 mg daily or higher, high-dose ritonavir, rifabutin, ergot alkaloids, St. John's Wort, naloxegol, tolvaptan, lurasidone, and venetoclax during the CLL/SLL initiation/ramp-up phase are contraindicated with voriconazole because of the risk of serious and/or life-threatening reactions or loss of efficacy. | Before starting voriconazole, give the prescriber and pharmacist a complete list of all medicines (prescription, over-the-counter, and herbal supplements). (1) |
| Phenytoin | When co-administration cannot be avoided, the adult voriconazole maintenance dose is increased to 400 mg orally every 12 hours. | Dose adjustment must be managed by the prescriber; do not alter the dose yourself. (1) |
| Efavirenz 300 mg once daily | When co-administered (at this lower efavirenz dose), the voriconazole maintenance dose is increased to 400 mg every 12 hours and the efavirenz dose is decreased to 300 mg once daily. | This combination must only be managed with prescriber-directed dose adjustments. (1) |
| Corticosteroids | Adrenal dysfunction may occur. Patients receiving voriconazole together with corticosteroids require careful monitoring both during and after voriconazole treatment. | Monitoring for adrenal dysfunction is recommended; specific symptom detail was not established in the sources reviewed for this article. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
Voriconazole is approved for patients aged 2 years and older. For ages 2 to less than 12 years, and ages 12‑14 years weighing less than 50 kg, the dosing algorithm differs from the adult regimen. Patients 12‑14 years weighing 50 kg or more and all patients aged 15 years or older use the adult regimen. Pediatric-specific adverse-reaction data were not extracted in this research pass; discuss risk in detail with the paediatric specialist. (1)
Hepatic impairment
In adults with mild to moderate cirrhosis (Child-Pugh Class A and B), the standard loading dose is used but the maintenance dose is halved. The current US label gives no recommendation for severe (Child-Pugh Class C) cirrhosis; dosing must be determined by the specialist with close monitoring. (1)
Renal impairment (IV route)
In adult patients with moderate to severe renal impairment (creatinine clearance below 50 mL/min), the intravenous formulation should be avoided because of accumulation of the cyclodextrin vehicle. The oral formulation is preferred in these patients. Pediatric-specific renal-impairment guidance was not established in the sources reviewed for this article. (1)
Pregnancy
Voriconazole can cause fetal harm based on animal reproduction data. Females of reproductive potential must use effective contraception during treatment. Pregnancy status should be evaluated before starting. (1)
Breastfeeding
No breastfeeding-specific guidance was identified in the research material reviewed for this draft. Discuss with the specialist.
Monitoring
Before starting
- Confirm the diagnosis, indication, and local eligibility criteria.
- Obtain baseline liver function tests (evaluated at the start of treatment per the reviewed label). A baseline visual-function assessment was not established in the sources reviewed for this article.
- Evaluate cardiac history (especially QT prolongation, cardiomyopathy) and correct electrolyte imbalances (potassium, magnesium, calcium).
- Review all medicines for contraindicated and interacting drugs.
- Assess pregnancy status and discuss effective contraception for females of reproductive potential.
During treatment
- Monitor liver function tests at least weekly for the first month and as clinically indicated thereafter.
- Monitor visual function (visual acuity, visual field, color perception) if treatment extends beyond 28 days.
- Monitor for skin changes and counsel on strict sun protection; arrange dermatologic evaluation if premalignant or malignant lesions appear.
- Correct potassium, magnesium, and calcium abnormalities before and during therapy. A specific QT-interval monitoring protocol was not established in the sources reviewed for this article.
- Monitor for pancreatitis in patients with relevant risk factors.
- Monitor for adrenal dysfunction in patients also receiving corticosteroids.
Storage
Follow the specific storage instructions on the product packaging. General handling and storage details beyond this point were not extracted in this research pass; confirm the exact requirements with the pharmacist or product information leaflet.
Professional information
Clinician-facing context only. All facts are drawn from the US FDA-approved prescribing information for voriconazole tablets. Use the current local product label, indication-specific guidelines, and clinical judgment for the exact dosing regimen, monitoring schedule, and interaction management.
United States (FDA labeling)
Indication: Invasive aspergillosis (adults)
Dose summary: Loading dose: 6 mg/kg IV every 12 h for the first 24 h. Maintenance: 4 mg/kg IV every 12 h, or 200 mg orally every 12 h.
Renal context: Avoid IV formulation in adults with CrCl <50 mL/min because of the cyclodextrin vehicle; oral formulation is preferred. (1)
United States (FDA labeling)
Indication: Candidemia in non-neutropenic patients and disseminated Candida infections (adults)
Dose summary: Loading dose: 6 mg/kg IV every 12 h for the first 24 h. Maintenance: 3‑4 mg/kg IV every 12 h, or 200 mg orally every 12 h.
Renal context: Same IV-avoidance advice in CrCl <50 mL/min applies. (1)
United States (FDA labeling)
Indication: Esophageal candidiasis (adults)
Dose summary: Oral only: 200 mg every 12 h.
Renal context: Oral formulation preferred in moderate-to-severe renal impairment; no oral dose adjustment for cyclodextrin concerns. (1)
United States (FDA labeling)
Indication: Pediatric patients (2 to <12 years, and 12‑14 years weighing <50 kg)
Dose summary: Loading dose: 9 mg/kg IV every 12 h for the first 24 h. Maintenance: 8 mg/kg IV every 12 h, or 9 mg/kg orally every 12 h (maximum oral dose 350 mg every 12 h).
Renal context: Pediatric-specific renal-impairment/IV-avoidance guidance was not established in the sources reviewed for this article; this remains (1)
United States (FDA labeling)
Indication: Adolescents 12‑14 years weighing ≥50 kg and all patients aged 15 years or older
Dose summary: Adult dosing regimen applies.
Renal context: Same IV-avoidance advice in CrCl <50 mL/min applies. (1)
Hepatic guidance
Mild-to-moderate cirrhosis (Child-Pugh A/B): use standard loading dose; halve the maintenance dose. No recommendation is provided in the reviewed label for severe (Child-Pugh C) cirrhosis.
Overdose note
Information on overdose signs, symptoms, and management was not identified in the research material reviewed for this draft. Managed under specialist and/or poison-centre guidance. (1)
Frequently asked questions
Can I take voriconazole if I am pregnant or could become pregnant?
Voriconazole can cause harm to an unborn baby, based on animal reproduction data. Females who can become pregnant must use effective contraception throughout treatment. Specific guidance on what action to take if pregnancy is suspected was not established in the sources reviewed for this article. (1)
Why do I need blood tests so frequently while taking voriconazole?
Voriconazole can affect the liver, and serious liver reactions have occurred. Liver function tests are checked at the start and at least weekly for the first month to detect problems early. (1)
Do I need to protect my skin from the sun while on this medicine?
Yes. Voriconazole can make the skin very sensitive to sunlight, and some patients have developed skin cancers with long-term use. Avoid strong direct sunlight, wear protective clothing, and use a high‑SPF sunscreen. Report any new or changing skin lesion to your prescriber. (1)
What is the mechanism of action of voriconazole?
Voriconazole is a triazole antifungal. Its primary mechanism of action is inhibition of fungal cytochrome P450-mediated 14-alpha-sterol demethylation, an essential step in fungal cell membrane ergosterol synthesis. (1)
What is the generic name of Voriconazole?
The generic name is voriconazole. It is sold under brand names including VFEND. (1)
What class of drug is voriconazole?
Voriconazole is classed as: Triazole antifungal. (1)
References
- VORICONAZOLE tablet, film coated — prescribing informationU.S. National Library of Medicine, DailyMed · United States · accessed 2026-08-05 · source 1
- VORICONAZOLE (VORICONAZOLE INJECTION) INJECTION [PAI HOLDINGS, LLC DBA PAI PHARMA] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 2
- Voriconazole — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 3
- VFEND — FDA approval record (Drugs@FDA NDA021267)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- voriconazole — RxNorm normalized drug concept (RXCUI 121243)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient voriconazole names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- VFEND40 mg/mL, 10 mg/mL, 200 mg · roerig
Canada
- VFEND