Vcand 4 gm/100 ml Suspension

Broad-spectrum triazole antifungal for serious fungal infections:

• Invasive aspergillosis
• Candidaemia and serious invasive Candida infections (including fluconazole-resistant)
• Oesophageal candidiasis
• Serious infections caused by Scedosporium and Fusarium
• Prevention in high-risk transplant patients
• Eye drops (compounded/fortified): fungal keratitis

Adults (oral), 40 kg and over: loading 400 mg every 12 hours for the first day, then 200 mg every 12 hours (may be increased to 300 mg every 12 hours).

Adults under 40 kg: 200 mg every 12 hours on day 1, then 100 mg every 12 hours.

IV (hospital): 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg every 12 hours.

Children 2–12 years: weight-based dosing by specialist.

• Take tablets at least 1 hour before or after a meal.
• Liver impairment: maintenance dose halved.

• Allergy to voriconazole
• Use with rifampicin, carbamazepine, phenobarbital, St John's wort, high-dose ritonavir, efavirenz (high dose), rifabutin
• Use with pimozide, quinidine, ivabradine, ergot alkaloids, sirolimus, simvastatin/lovastatin (dangerous interactions)

Very common: visual disturbances (blurred, altered colour vision, light sensitivity — usually temporary), fever, rash, nausea, vomiting, diarrhoea, headache, swelling of legs.

Common: liver test abnormalities, hallucinations, low potassium, sun sensitivity.

Rare but serious: liver failure, QT prolongation and irregular heartbeat, severe skin reactions, skin cancer with long-term use, bone inflammation (fluorosis) with prolonged use.

• Check liver function and potassium/magnesium before and during treatment.
• Avoid sunlight and use sunscreen; avoid driving at night (vision changes).
• Heart rhythm disorders: ECG monitoring.

Avoid in pregnancy unless benefit clearly outweighs risk; use contraception. Avoid breastfeeding during treatment.

Many serious interactions (CYP enzymes):

• Contraindicated drugs listed above
• Warfarin, ciclosporin, tacrolimus, omeprazole, phenytoin, methadone, oxycodone, NSAIDs, sulphonylureas, benzodiazepines (dose adjustment and monitoring)
• Other QT-prolonging drugs

Light sensitivity, visual problems, QT effects. Supportive care.

Store below 30°C.