{"id":53698,"date":"2023-09-20T09:49:34","date_gmt":"2023-09-20T09:49:34","guid":{"rendered":"https:\/\/medsname.com\/vorier\/"},"modified":"2026-04-30T10:25:10","modified_gmt":"2026-04-30T10:25:10","slug":"vorier","status":"publish","type":"product","link":"https:\/\/medsbase.com\/el\/vorier\/","title":{"rendered":"Vorier"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:14px 20px;margin:18px 0;border-radius:6px;\">\n<h3 style=\"margin-top:0;\">\ud83d\udca1 \u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03b7 \u0391\u03c0\u03ac\u03bd\u03c4\u03b7\u03c3\u03b7<\/h3>\n<p style=\"margin-bottom:0;\">Vorier is voriconazole 200 mg oral tablet \u2014 a second-generation triazole and the <strong>first-line treatment for invasive aspergillosis<\/strong>. Also covers Candida (including some fluconazole-resistant strains), Scedosporium, Fusarium. Specialist hospital-initiated drug \u2014 TDM (trough 1\u20135.5 mg\/L) required, mandatory ophthalmology baseline (visual disturbances common), and frequent LFT monitoring. Hugely complex pharmacokinetics: non-linear (CYP2C19 polymorphism), strong CYP3A4 inhibitor, photosensitivity \u2192 skin cancer risk on long-term use.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f5f5f5;border:1px solid #e1e1e1;padding:18px 22px;margin:24px 0;border-radius:8px;display:flex;flex-wrap:wrap;justify-content:space-around;gap:16px;align-items:center;font-size:0.95em;\">\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83c\udfed<br \/><strong>WHO-GMP<\/strong><br \/>\u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03b7\u03bc\u03ad\u03bd\u03bf\u03c2 \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ae\u03c2<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 \u039a\u03ac\u03b8\u03b5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03ba\u03b1\u03bb\u03cd\u03c0\u03c4\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd <a href=\"https:\/\/medsbase.com\/el\/medsbase-re-shipment-assurance-policy\/\"><strong>\u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0395\u03b3\u03b3\u03cd\u03b7\u03c3\u03b7\u03c2 \u0395\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae\u03c2<\/strong><\/a> \u2014 \u03b5\u03ac\u03bd \u03c4\u03bf \u03b4\u03ad\u03bc\u03b1 \u03c3\u03b1\u03c2 \u03b4\u03b5\u03bd \u03c6\u03c4\u03ac\u03c3\u03b5\u03b9 \u03b5\u03bd\u03c4\u03cc\u03c2 20 \u03b5\u03c1\u03b3\u03ac\u03c3\u03b9\u03bc\u03c9\u03bd \u03b7\u03bc\u03b5\u03c1\u03ce\u03bd, \u03c4\u03bf \u03b5\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03ad\u03bb\u03bb\u03bf\u03c5\u03bc\u03b5.<\/p>\n<h3>\u0393\u03b9\u03b1\u03c4\u03af \u03bd\u03b1 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03af\u03bb\u03b5\u03c4\u03b5 \u03b1\u03c0\u03cc \u03c4\u03b7 MedsBase<\/h3>\n<p>\u03a4\u03b1 \u03b3\u03b5\u03bd\u03cc\u03c3\u03b7\u03bc\u03b1 \u03c6\u03ac\u03c1\u03bc\u03b1\u03ba\u03ac \u03bc\u03b1\u03c2 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ad\u03c2 \u03c0\u03bf\u03c5 \u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd WHO-GMP \u03ba\u03b1\u03b9 \u03b1\u03c0\u03bf\u03c3\u03c4\u03ad\u03bb\u03bb\u03bf\u03bd\u03c4\u03b1\u03b9 \u03c0\u03b1\u03b3\u03ba\u03bf\u03c3\u03bc\u03af\u03c9\u03c2 \u03c3\u03b5 \u03b4\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae, \u03b1\u03c0\u03bb\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1 \u2014 \u03c7\u03c9\u03c1\u03af\u03c2 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5 \u03c3\u03c4\u03bf \u03b5\u03be\u03c9\u03c4\u03b5\u03c1\u03b9\u03ba\u03cc \u03c4\u03bf\u03c5 \u03b4\u03ad\u03bc\u03b1\u03c4\u03bf\u03c2. \u039f\u03b9 \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03c2 \u03bc\u03b5 \u03ba\u03ac\u03c1\u03c4\u03b1 \u03b4\u03c1\u03bf\u03bc\u03bf\u03bb\u03bf\u03b3\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03bc\u03ad\u03c3\u03c9 \u03c1\u03c5\u03b8\u03bc\u03b9\u03c3\u03bc\u03ad\u03bd\u03bf\u03c5 \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03ae (\u03bf\u03b9 \u03c0\u03b5\u03c1\u03b9\u03b3\u03c1\u03b1\u03c6\u03ad\u03c2 \u03b5\u03ba\u03ba\u03b1\u03b8\u03ac\u03c1\u03b9\u03c3\u03b7\u03c2 \u03c0\u03b5\u03c1\u03b9\u03bb\u03b1\u03bc\u03b2\u03ac\u03bd\u03bf\u03c5\u03bd \u03c1\u03c5\u03b8\u03bc\u03b9\u03c3\u03bc\u03ad\u03bd\u03bf \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03ae \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ce\u03bd \u03bc\u03b5 \u03ba\u03ac\u03c1\u03c4\u03b1 \u2014 \u03c0\u03bf\u03c4\u03ad \u201cMedsBase\u201d \u03ae \u03bf\u03c0\u03bf\u03b9\u03bf\u03b4\u03ae\u03c0\u03bf\u03c4\u03b5 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5). \u0393\u03af\u03bd\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b4\u03b5\u03ba\u03c4\u03ad\u03c2 \u03ba\u03b1\u03b9 \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03c2 \u03bc\u03b5 \u03ba\u03c1\u03c5\u03c0\u03c4\u03bf\u03bd\u03bf\u03bc\u03af\u03c3\u03bc\u03b1\u03c4\u03b1 \u03ba\u03b1\u03b9 \u03c4\u03c1\u03b1\u03c0\u03b5\u03b6\u03b9\u03ba\u03ae \u03bc\u03b5\u03c4\u03b1\u03c6\u03bf\u03c1\u03ac SEPA. \u039a\u03ac\u03b8\u03b5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03ba\u03b1\u03bb\u03cd\u03c0\u03c4\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd \u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0395\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae\u03c2 \u0395\u03be\u03b1\u03c3\u03c6\u03b1\u03bb\u03af\u03c3\u03b5\u03ce\u03c2 \u03bc\u03b1\u03c2.<\/p>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83d\udce6<br \/><strong>\u0394\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1<\/strong><br \/>\u03b1\u03c0\u03bb\u03cc \u03c6\u03ac\u03ba\u03b5\u03bb\u03bf<\/div>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83c\udf0d<br \/><strong>\u03a0\u03b1\u03b3\u03ba\u03cc\u03c3\u03bc\u03b9\u03b1 \u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae<\/strong><br \/>\u03c3\u03c4\u03b9\u03c2 \u03c0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03b5\u03c2 \u03c7\u03ce\u03c1\u03b5\u03c2<\/div>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\u2b50<br \/><strong>1,400+ \u03c0\u03b5\u03bb\u03ac\u03c4\u03b5\u03c2<\/strong><br \/><a href=\"https:\/\/medsbase.com\/el\/reviews\/\">\u03b4\u03b9\u03b1\u03b2\u03ac\u03c3\u03c4\u03b5 \u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ad\u03c2<\/a><\/div>\n<\/div>\n<h2>\ud83d\udd12 Why order Vorier from MedsBase<\/h2>\n<ul>\n<li><strong>\u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03b7\u03bc\u03ad\u03bd\u03bf \u03b1\u03c0\u03cc \u03c4\u03b7 WHO-GMP \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ae<\/strong> \u2014 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c1\u03c5\u03b8\u03bc\u03b9\u03b6\u03cc\u03bc\u03b5\u03bd\u03b7 \u03b5\u03b3\u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b1\u03c3\u03b7, \u03bf\u03bb\u03bf\u03ba\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03bd\u03b7 \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1 \u03bc\u03b5 \u03b1\u03c1\u03b9\u03b8\u03bc\u03cc \u03c0\u03b1\u03c1\u03c4\u03af\u03b4\u03b1\u03c2 \u03ba\u03b1\u03b9 \u03b7\u03bc\u03b5\u03c1\u03bf\u03bc\u03b7\u03bd\u03af\u03b1 \u03bb\u03ae\u03be\u03b7\u03c2.<\/li>\n<li><strong>\u0394\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1<\/strong> \u2014 \u03b1\u03c0\u03bb\u03cc \u03c6\u03ac\u03ba\u03b5\u03bb\u03bf, \u03c7\u03c9\u03c1\u03af\u03c2 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5 \u03c3\u03c4\u03bf \u03b5\u03be\u03c9\u03c4\u03b5\u03c1\u03b9\u03ba\u03cc.<\/li>\n<li><strong>\u03a0\u03b1\u03b3\u03ba\u03cc\u03c3\u03bc\u03b9\u03b1 \u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae<\/strong> \u03c3\u03c4\u03b9\u03c2 \u03c0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03b5\u03c2 \u03c7\u03ce\u03c1\u03b5\u03c2 \u03bc\u03b5 <a href=\"https:\/\/medsbase.com\/el\/medsbase-re-shipment-assurance-policy\/\">Reshipment Assurance<\/a>.<\/li>\n<li><strong>\u03a0\u03cc\u03bd\u03c4\u03bf\u03b9 \u03b1\u03c6\u03bf\u03c3\u03af\u03c9\u03c3\u03b7\u03c2<\/strong> \u2014 1 \u03c0\u03cc\u03bd\u03c4\u03bf\u03c2 \u03b1\u03bd\u03ac $1 \u03c0\u03bf\u03c5 \u03be\u03bf\u03b4\u03b5\u03cd\u03b5\u03c4\u03b5 (\u03b5\u03be\u03b1\u03b9\u03c1\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03c4\u03b1 \u03c0\u03b5\u03c0\u03c4\u03af\u03b4\u03b9\u03b1\/\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae)\u00b7 100 \u03c0\u03cc\u03bd\u03c4\u03bf\u03c5\u03c2 = $5 \u03ad\u03ba\u03c0\u03c4\u03c9\u03c3\u03b7 \u03c3\u03c4\u03b7\u03bd \u03b5\u03c0\u03cc\u03bc\u03b5\u03bd\u03b7 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03c3\u03b1\u03c2.<\/li>\n<\/ul>\n<h2 id=\"uses\">\u03a7\u03c1\u03ae\u03c3\u03b5\u03b9\u03c2 &amp; \u03b5\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2<\/h2>\n<p>Vorier (voriconazole 200 mg, Glenmark) is a specialist antifungal \u2014 first-line for invasive aspergillosis (Herbrecht 2002 NEJM trial established this), and an option for invasive candidiasis, Scedosporium and Fusarium infections, oesophageal candidiasis refractory to fluconazole, and febrile neutropenia in selected cases. <strong>It is not a first-line drug for vaginal thrush, oral thrush, or onychomycosis<\/strong> \u2014 use fluconazole or terbinafine for those.<\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u0395\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u03a4\u03c5\u03c0\u03b9\u03ba\u03cc \u03c3\u03c7\u03ae\u03bc\u03b1 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\u03c2<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Invasive aspergillosis<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">IV loading 6 mg\/kg q12h \u00d7 24 h, then 4 mg\/kg q12h IV; or oral 200 mg q12h (\u2265 40 kg) \/ 100 mg q12h (&lt; 40 kg)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Candidaemia (non-neutropenic)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Same dosing \u2014 14 days minimum after first negative blood culture<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Oesophageal candidiasis (fluconazole-refractory)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg q12h \u00d7 14\u201321 days<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Scedosporium \/ Fusarium infection<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg q12h, duration based on response<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Empirical therapy in febrile neutropenia<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg q12h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"how-to-take\">\u03a0\u03ce\u03c2 \u03bd\u03b1 \u03c0\u03ac\u03c1\u03b5\u03c4\u03b5<\/h2>\n<ul>\n<li>Take 1 hour before or 1 hour after a meal \u2014 food reduces absorption ~22%.<\/li>\n<li>\u039a\u03b1\u03c4\u03b1\u03c0\u03b9\u03b5\u03af\u03c4\u03b5 \u03bf\u03bb\u03cc\u03ba\u03bb\u03b7\u03c1\u03bf \u03bc\u03b5 \u03bd\u03b5\u03c1\u03cc.<\/li>\n<li>Loading dose is critical \u2014 without it, steady-state takes 5\u20137 days to reach.<\/li>\n<li>Therapeutic drug monitoring (trough 1\u20135.5 mg\/L) at day 5\u20137 and after dose change.<\/li>\n<\/ul>\n<h2 id=\"mechanism\">\u03a0\u03ce\u03c2 \u03bb\u03b5\u03b9\u03c4\u03bf\u03c5\u03c1\u03b3\u03b5\u03af<\/h2>\n<p>Voriconazole inhibits fungal CYP51 with a higher affinity than fluconazole, extending coverage to Aspergillus and most non-albicans Candida. Pharmacokinetics are non-linear in adults \u2014 small dose changes cause large concentration changes. CYP2C19 polymorphism: poor metabolisers (15% of East Asians, 3% of Caucasians) have 4\u00d7 higher levels; ultra-rapid metabolisers may not reach therapeutic levels. <strong>This is why TDM is mandatory.<\/strong><\/p>\n<h2 id=\"side-effects\">\u03a0\u03b1\u03c1\u03b5\u03bd\u03ad\u03c1\u03b3\u03b5\u03b9\u03b5\u03c2 &amp; \u03c0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03cd\u03b8\u03b7\u03c3\u03b7<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u03a3\u03c5\u03c7\u03bd\u03cc\u03c4\u03b7\u03c4\u03b1<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">Effects<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Very common<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\"><strong>Visual disturbances<\/strong> \u2014 blurred vision, photopsia, altered colour perception (~30%, especially in first week, reversible)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a3\u03c5\u03c7\u03bd\u03ac<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Rash, nausea, vomiting, abdominal pain, diarrhoea, peripheral oedema, fever, raised LFTs<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03c3\u03c5\u03bd\u03ae\u03b8\u03b9\u03c3\u03c4\u03b5\u03c2<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Photosensitivity \/ phototoxicity, hallucinations, confusion, hypokalaemia<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a3\u03c0\u03ac\u03bd\u03b9\u03b1 \u03b1\u03bb\u03bb\u03ac \u03c3\u03bf\u03b2\u03b1\u03c1\u03ae<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Hepatotoxicity (including fatal hepatitis), QT prolongation \/ torsades, SJS\/TEN, periostitis (long-term \u2014 fluoride accumulation), squamous-cell skin cancer (long-term photosensitivity)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 20px;margin:20px 0;border-radius:6px;\"><strong>Skin cancer warning<\/strong><\/p>\n<div>Voriconazole induces severe photosensitivity and is associated with squamous-cell carcinoma on chronic therapy (most cases &gt; 6 months continuous use). Patients on long-term voriconazole must use SPF 50+ broad-spectrum sunscreen daily, avoid direct sun, and have annual dermatology screening. Any new skin lesion on a sun-exposed area = immediate dermatology referral.<\/div>\n<\/div>\n<h2 id=\"interactions\">Drug interactions \u2014 extensive<\/h2>\n<p>Voriconazole is metabolised by CYP2C19, CYP2C9, CYP3A4 \u2014 and is itself a strong inhibitor of all three. Major concerns:<\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u03a6\u03ac\u03c1\u03bc\u03b1\u03ba\u03bf<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u0391\u03c0\u03bf\u03c4\u03ad\u03bb\u03b5\u03c3\u03bc\u03b1<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u0394\u03c1\u03ac\u03c3\u03b7<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Rifampicin \/ rifabutin \/ carbamazepine \/ phenobarbital<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Potent induction \u2192 undetectable voriconazole<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0392\u03ac\u03bb\u03c3\u03b1\u03bc\u03bf \u03c4\u03bf\u03c5 \u0391\u03b3\u03af\u03bf\u03c5 \u0399\u03c9\u03ac\u03bd\u03bd\u03b7<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Same induction effect<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Sirolimus<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">8\u00d7 rise \u2014 severe toxicity<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Pimozide \/ quinidine \/ terfenadine \/ cisapride<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0395\u03c0\u03ad\u03ba\u03c4\u03b1\u03c3\u03b7 QT<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0395\u03c1\u03b3\u03bf\u03c4\u03b1\u03bb\u03b9\u03ba\u03ac \u03b1\u03bb\u03ba\u03b1\u03bb\u03bf\u03b5\u03b9\u03b4\u03ae<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Vasoconstriction \u2192 ergotism<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Tacrolimus \/ ciclosporin<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">2\u20133\u00d7 rise<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u039c\u03b5\u03af\u03c9\u03c3\u03b7 \u03b4\u03cc\u03c3\u03b7\u03c2\u00b7 \u03c0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03cd\u03b8\u03b7\u03c3\u03b7 \u03b5\u03bb\u03ac\u03c7\u03b9\u03c3\u03c4\u03b7\u03c2 \u03c3\u03c5\u03b3\u03ba\u03ad\u03bd\u03c4\u03c1\u03c9\u03c3\u03b7\u03c2<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0392\u03b1\u03c1\u03c6\u03b1\u03c1\u03af\u03bd\u03b7<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">INR rises<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Monitor INR closely<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Statins (simvastatin, atorvastatin)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Rhabdomyolysis risk<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Stop or switch to pravastatin<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a6\u03b1\u03b9\u03bd\u03c5\u03c4\u03bf\u0390\u03bd\u03b7<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Bidirectional \u2014 voriconazole levels fall, phenytoin levels rise<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Avoid; if used, increase voriconazole 100% and monitor phenytoin<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Omeprazole \/ esomeprazole<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">PPI levels rise; modest effect on voriconazole<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Halve PPI dose<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Methadone, opioids<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Increased CNS depression<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Reduce opioid dose<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"monitoring\">\u03a5\u03c0\u03bf\u03c7\u03c1\u03b5\u03c9\u03c4\u03b9\u03ba\u03ae \u03c0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03cd\u03b8\u03b7\u03c3\u03b7<\/h2>\n<ul>\n<li><strong>Therapeutic drug monitoring<\/strong> \u2014 trough plasma level at day 5\u20137 and after every dose change. Target 1.0\u20135.5 mg\/L (some labs 2.0\u20135.5 for invasive aspergillosis).<\/li>\n<li><strong>\u039b\u03b5\u03b9\u03c4\u03bf\u03c5\u03c1\u03b3\u03af\u03b1 \u03c4\u03bf\u03c5 \u03ae\u03c0\u03b1\u03c4\u03bf\u03c2<\/strong> \u2014 baseline, then weekly for 2\u20134 weeks, then monthly while on therapy.<\/li>\n<li><strong>Visual function<\/strong> \u2014 baseline ophthalmology if therapy &gt; 28 days expected.<\/li>\n<li><strong>Renal function<\/strong> \u2014 IV form contains cyclodextrin; avoid in CrCl &lt; 50 unless benefit clearly outweighs risk (oral form is fine).<\/li>\n<li><strong>Skin \/ dermatology<\/strong> \u2014 annual review on long-term therapy.<\/li>\n<\/ul>\n<h2 id=\"contraindications\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2<\/h2>\n<ul>\n<li>Concurrent rifampicin, rifabutin, carbamazepine, phenobarbital, St John&#8217;s wort.<\/li>\n<li>Concurrent pimozide, quinidine, terfenadine, cisapride, ergot alkaloids, sirolimus.<\/li>\n<li>Pregnancy (teratogenicity).<\/li>\n<li>Severe hepatic impairment.<\/li>\n<li>Hypersensitivity to other azoles.<\/li>\n<\/ul>\n<h2 id=\"pregnancy\">\u0395\u03b3\u03ba\u03c5\u03bc\u03bf\u03c3\u03cd\u03bd\u03b7 &amp; \u03b8\u03b7\u03bb\u03b1\u03c3\u03bc\u03cc\u03c2<\/h2>\n<p>Voriconazole is teratogenic in animals and contraindicated in pregnancy except in life-threatening systemic mycoses. Effective contraception required. Excretion in breast milk unknown \u2014 alternatives preferred while breastfeeding.<\/p>\n<h2 id=\"faqs\">\u03a3\u03c5\u03c7\u03bd\u03ad\u03c2 \u0395\u03c1\u03c9\u03c4\u03ae\u03c3\u03b5\u03b9\u03c2<\/h2>\n<h3>I see flashes of light when I take voriconazole \u2014 is that normal?<\/h3>\n<p>Yes \u2014 visual disturbances (photopsia, blurred vision, altered colour perception) occur in ~30% of patients, usually within the first 2 hours of dosing and resolve over days to weeks even on continued therapy. Do not drive at night until the effect is clear. If severe or persistent, request TDM \u2014 high troughs make it worse.<\/p>\n<h3>Why is everyone so worried about my CYP2C19 status?<\/h3>\n<p>Voriconazole is metabolised by CYP2C19. Poor metabolisers (15% of East Asian descent, 3% of Caucasians) have 4\u00d7 higher exposure at standard doses \u2192 toxicity. Ultra-rapid metabolisers may not reach therapeutic levels \u2192 treatment failure. Pharmacogenetic testing or simply TDM at day 5\u20137 fixes this.<\/p>\n<h3>Can I switch from IV to oral voriconazole?<\/h3>\n<p>Yes \u2014 once the patient is stable and tolerating oral. The oral bioavailability is ~96% in adults, so the dose is the same (200 mg q12h for adults \u2265 40 kg).<\/p>\n<h3>What sunscreen should I use?<\/h3>\n<p>Broad-spectrum SPF 50+ minimum, daily, including on cloudy days. Reapply every 2 hours when outdoors. Long-sleeve UV-protective clothing for prolonged exposure. Avoid sunbeds completely.<\/p>\n<h3>What are &#8216;periostitis&#8217; and &#8216;fluoride toxicity&#8217;?<\/h3>\n<p>Voriconazole contains fluoride. Long-term therapy (months) can cause painful periostitis with elevated alkaline phosphatase and serum fluoride. Bone scan shows uptake. Resolves on discontinuation. New unexplained bone pain on long-term therapy \u2014 get an ALP and serum fluoride.<\/p>\n<h3>Is voriconazole the same as Vfend?<\/h3>\n<p>Yes \u2014 Vfend is the original Pfizer brand. Vorier contains the same active ingredient, manufactured by Glenmark under WHO-GMP. Bioequivalent.<\/p>\n<h3>Why does my onychomycosis specialist not use voriconazole?<\/h3>\n<p>Voriconazole is reserved for invasive systemic mycoses. For dermatophyte nail infection (the common cause), terbinafine 250 mg\/day \u00d7 12 weeks is first-line \u2014 better cure rate, fewer interactions, far cheaper. Voriconazole would be used only for unusual moulds (Scedosporium, Fusarium) confirmed on culture.<\/p>\n<h3>What if I have hepatitis on voriconazole?<\/h3>\n<p>Stop voriconazole if AST\/ALT &gt; 5\u00d7 ULN, or any rise + symptoms (jaundice, dark urine, RUQ pain). Switch to alternative (caspofungin \/ micafungin \/ amphotericin B \/ posaconazole \/ isavuconazole depending on indication). Rechallenge sometimes possible at lower dose with close monitoring.<\/p>\n<h3>Can I take voriconazole with PPIs?<\/h3>\n<p>Voriconazole inhibits CYP2C19, raising omeprazole and esomeprazole levels by ~2\u00d7. Halve the PPI dose if continuing. Pantoprazole and rabeprazole are less affected. The interaction does not significantly alter voriconazole levels.<\/p>\n<h3>What&#8217;s TDM and why every week at first?<\/h3>\n<p>Therapeutic drug monitoring \u2014 measuring trough voriconazole plasma level. Target 1\u20135.5 mg\/L. Below 1: treatment failure risk. Above 5.5: hepatotoxicity, encephalopathy, visual problems. CYP2C19 polymorphism makes the dose-response unpredictable, so TDM is non-negotiable for invasive aspergillosis.<\/p>\n<h2 id=\"storage\">\u0391\u03c0\u03bf\u03b8\u03ae\u03ba\u03b5\u03c5\u03c3\u03b7<\/h2>\n<p>Store tablets at 15\u201330 \u00b0C in the original pack. Protect from light. Do not use after expiry. Keep out of reach of children.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2>\u0386\u03bb\u03bb\u03b1 \u0391\u03bd\u03c4\u03b9\u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03ac \u03a6\u03ac\u03c1\u03bc\u03b1\u03ba\u03b1 \u03c0\u03bf\u03c5 \u03bc\u03c0\u03bf\u03c1\u03b5\u03af \u03bd\u03b1 \u03c3\u03b1\u03c2 \u03b5\u03bd\u03b4\u03b9\u03b1\u03c6\u03ad\u03c1\u03bf\u03c5\u03bd<\/h2>\n<p>Voriconazole is specialist therapy. Listed below \u2014 same molecule from a different manufacturer, plus first-line antifungals for the common indications where voriconazole is overkill.<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/el\/zocon\/\"><strong>Zocon (\u03c6\u03bb\u03bf\u03c5\u03ba\u03bf\u03bd\u03b1\u03b6\u03cc\u03bb\u03b7 150 mg)<\/strong><\/a> \u2014 First-line for non-Aspergillus Candida; well-tolerated.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/sporanox-capsule\/\"><strong>Sporanox (itraconazole 100 mg)<\/strong><\/a> \u2014 For dimorphic mycoses + non-Aspergillus moulds.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/zimig\/\"><strong>Zimig (terbinafine 250 mg)<\/strong><\/a> \u2014 Dermatophyte nail \/ skin infection (not invasive moulds).<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/clocip\/\"><strong>Clocip (clotrimazole 1%)<\/strong><\/a> \u2014 Topical Candida, dermatophyte tinea.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/loceryl-nail-liq\/\"><strong>Loceryl (amorolfine 5%)<\/strong><\/a> \u2014 Topical nail lacquer for mild onychomycosis.<\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 18px;margin:24px 0;font-size:0.95em;\"><strong>\u0399\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae \u03b1\u03c0\u03bf\u03c0\u03bf\u03af\u03b7\u03c3\u03b7 \u03b5\u03c5\u03b8\u03c5\u03bd\u03ce\u03bd.<\/strong> \u0391\u03c5\u03c4\u03ae \u03b7 \u03c3\u03b5\u03bb\u03af\u03b4\u03b1 \u03c0\u03b1\u03c1\u03ad\u03c7\u03b5\u03b9 \u03c0\u03bb\u03b7\u03c1\u03bf\u03c6\u03bf\u03c1\u03af\u03b5\u03c2 \u03c0\u03c1\u03bf\u03ca\u03cc\u03bd\u03c4\u03c9\u03bd \u03b3\u03b9\u03b1 \u03b5\u03bd\u03ae\u03bb\u03b9\u03ba\u03b5\u03c2 \u03c0\u03bf\u03c5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03ad\u03bb\u03bd\u03bf\u03c5\u03bd \u03b1\u03bd\u03c4\u03b9\u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03ac \u03c6\u03ac\u03c1\u03bc\u03b1\u03ba\u03b1 \u03b3\u03b9\u03b1 \u03c0\u03c1\u03bf\u03c3\u03c9\u03c0\u03b9\u03ba\u03ae \u03c7\u03c1\u03ae\u03c3\u03b7. \u0394\u03b5\u03bd \u03b1\u03c0\u03bf\u03c4\u03b5\u03bb\u03b5\u03af \u03c5\u03c0\u03bf\u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b1\u03c4\u03bf \u03b5\u03be\u03b1\u03c4\u03bf\u03bc\u03b9\u03ba\u03b5\u03c5\u03bc\u03ad\u03bd\u03b7\u03c2 \u03b9\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae\u03c2 \u03c3\u03c5\u03bc\u03b2\u03bf\u03c5\u03bb\u03ae\u03c2. \u03a3\u03c5\u03b6\u03b7\u03c4\u03ae\u03c3\u03c4\u03b5 \u03c4\u03bf \u03ba\u03b1\u03c4\u03ac\u03bb\u03bb\u03b7\u03bb\u03bf \u03b1\u03bd\u03c4\u03b9\u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03cc, \u03c4\u03b7 \u03b4\u03cc\u03c3\u03b7 \u03ba\u03b1\u03b9 \u03c4\u03b7 \u03b4\u03b9\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\u03c2 \u03bc\u03b5 \u03ad\u03bd\u03b1\u03bd \u03b5\u03b9\u03b4\u03b9\u03ba\u03b5\u03c5\u03bc\u03ad\u03bd\u03bf \u03ba\u03bb\u03b9\u03bd\u03b9\u03ba\u03cc \u2014 \u03b5\u03b9\u03b4\u03b9\u03ba\u03ac \u03b5\u03ac\u03bd \u03ad\u03c7\u03b5\u03c4\u03b5 \u03b7\u03c0\u03b1\u03c4\u03b9\u03ba\u03ae \u03bd\u03cc\u03c3\u03bf, \u03b5\u03af\u03c3\u03c4\u03b5 \u03ad\u03b3\u03ba\u03c5\u03bf\u03c2 \u03ae \u03b8\u03b7\u03bb\u03ac\u03b6\u03b5\u03c4\u03b5, \u03c0\u03b1\u03af\u03c1\u03bd\u03b5\u03c4\u03b5 warfarin, \u03c0\u03b1\u03af\u03c1\u03bd\u03b5\u03c4\u03b5 \u03c3\u03c4\u03b1\u03c4\u03af\u03bd\u03b7, \u03c0\u03b1\u03af\u03c1\u03bd\u03b5\u03c4\u03b5 \u03b1\u03bd\u03bf\u03c3\u03bf\u03ba\u03b1\u03c4\u03b1\u03c3\u03c4\u03b1\u03bb\u03c4\u03b9\u03ba\u03ac \u03ae \u03ad\u03c7\u03b5\u03c4\u03b5 \u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03ae \u03bc\u03cc\u03bb\u03c5\u03bd\u03c3\u03b7 \u03bd\u03c5\u03c7\u03b9\u03ce\u03bd \u03c0\u03bf\u03c5 \u03bc\u03c0\u03bf\u03c1\u03b5\u03af \u03bd\u03b1 \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03b9\u03b1\u03c6\u03bf\u03c1\u03b5\u03c4\u03b9\u03ba\u03ae \u03b4\u03b9\u03ac\u03b3\u03bd\u03c9\u03c3\u03b7 (\u03c8\u03c9\u03c1\u03af\u03b1\u03c3\u03b7, \u03b5\u03c1\u03c5\u03b8\u03b7\u03bc\u03b1\u03c4\u03ce\u03b4\u03b7\u03c2 \u03bb\u03b5\u03b9\u03c7\u03ae\u03bd\u03b1\u03c2, \u03c4\u03c1\u03b1\u03c5\u03bc\u03b1\u03c4\u03b9\u03c3\u03bc\u03cc\u03c2).<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<h5>\u2705 Rapid Fungal Infection Relief<br \/>\n\u2705 Effective Fungi Eradication<br \/>\n\u2705 Expert-Reviewed and Trusted<br \/>\n\u2705 Well-Tolerated, Common Effects<br \/>\n\u2705 Convenient Dosage Administration<\/h5>\n<p><span style=\"color: #999999;\">Vorier contains Voriconazole<\/span><\/p>","protected":false},"featured_media":53699,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3501,3141,3504,3342],"product_tag":[],"class_list":{"0":"post-53698","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-fungal","7":"product_cat-category-overview","8":"product_cat-fungal-infection-treatment","9":"product_cat-general-health","11":"first","12":"outofstock","13":"shipping-taxable","14":"purchasable","15":"product-type-variable","16":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product\/53698","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/comments?post=53698"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/media\/53699"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/media?parent=53698"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product_brand?post=53698"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product_cat?post=53698"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product_tag?post=53698"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}