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Introduction

Vori 200 belongs to a group of medicines called antifungals. It works by stopping the growth of fungus and is used to treat a wide range of fungal infections. It kills fungi by destroying the fungal cell membrane. Vori 200 should be taken in the dose and duration as prescribed by your doctor. It should be swallowed whole. It should be taken one hour before or one hour after a meal. The dosage and length of treatment will depend on the condition you are being treated for. Sometimes this will be in cycles of use and non-use. To get the most benefit, take this medicine at evenly spaced times and continue using it until your prescription is finished, even if your symptoms disappear after a few days. If you stop treatment too early, the infection may return and if you miss doses you can increase your risk of infections that are resistant to further treatment. Tell your doctor if the infection does not get better or if it gets worse. The most common side effects of this medicine include rash, vomiting, nausea, and headache. These are not usually serious, but you should call your doctor if you think you might have a severe allergic reaction. Signs of this include rash, swelling of the lips, throat, or face, swallowing or breathing problems, feeling dizzy or faint, and nausea. Get emergency help if this happens. Do not take it if you are pregnant or could become pregnant unless your doctor has told you to. Talk to your doctor before taking it if you have ever had heart failure, a weak immune system (including HIV/AIDS), kidney problems, or liver problems such as yellow skin (jaundice). This medicine may not be suitable for you. If your course of treatment is for more than a month, your doctor may want to check your liver by testing your blood. This medicine may make you dizzy or have blurred vision so do not drive or operate machines until it is safe.

Uses of Vori 200

• Severe fungal infections

Side effects of Vori 200

Common

• Abnormal liver function tests
• Hallucination
• Slow heart rate
• Altered vision
• Headache
• Nausea
• Rash
• Vomiting

How to use Vori 200

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Vori 200 is to be taken empty stomach.

How Vori 200 works

Vori 200 is an antifungal medication. It kills and stops the growth of the fungi by destroying their cell membrane, thereby treating your skin infection.

Quick Tips

• Your doctor has prescribed Vori 200 to cure your infection and improve your symptoms.
• Do not skip any doses and finish the full course of treatment even if you feel better.
• It should be taken one hour before or one hour after a meal.
• Do not take indigestion remedies (antacids) within two hours of taking Vori 200.
• Your doctor may check your liver function before starting treatment and regularly thereafter. Inform your doctor if you notice yellowing of eyes or skin, dark urine, or stomach pain.
• Inform your doctor if you are pregnant, planning pregnancy,, or breastfeeding.

Brief Description

Indication

Candidemia, Deep tissue Candida infections, Invasive aspergillosis, Scedosporiosis,, and Fusariosis

Administration

Should be taken on an empty stomach. Take at least 1 hr before or after meals. Infuse IV over 1-2 hr, not to exceed 3 mg/kg/hr

Adult Dose

Adult Invasive Aspergillosis, Candidemia, Serious Fungal Infections 6 mg/kg IV q12hr for first 24 hours, then 4 mg/kg IV q12hr or 200 mg PO q12hr Esophageal Candidiasis Candida albicans, Candida glabrata, Candida krusei 200 mg PO q12hr Hepatic impairment: Mild to moderate (Child-Pugh category A and B): Standard loading dose but maintenance doses should be reduced by 50%.

Child Dose

<12 years: Safety and efficacy not established Child >12 years Invasive Aspergillosis, Candidemia, Serious Fungal Infections 6 mg/kg IV q12hr for first 24 hours, then 4 mg/kg IV q12hr or 200 mg PO q12hr Esophageal Candidiasis Candida albicans, Candida glabrata, Candida krusei 200 mg PO q12hr

Contraindication

Hypersensitivity. Co-admin w/ CYP3A4 substrates, terfenadine, astemizole, cisapride, pimozide, quinidine, rifampicin, carbamazepine, long-acting barbiturates (e.g. phenobarbital, mephobarbital), ergot alkaloids (e.g. ergotamine and dihydroergotamine), efavirenz (≥400 mg once daily), ritonavir (≥400 mg bid), sirolimus, rifabutin, St John’s wort.

Mode of Action

Voriconazole is a triazole antifungal agent which inhibits cytochrome P450-dependent enzymes thereby inhibiting ergosterol synthesis in fungal cell membranes. It has a broad spectrum of activity against all Candida spp. including strains resistant to fluconazole), Aspergillus spp., Scedosporium spp., and Fusarium spp.

Precaution

Patient w/ potentially proarrhythmic conditions, the risk for acute pancreatitis. Correct electrolyte disturbances e.g. hypokalaemia, hypomagnesemia,,,, and hypocalcemia before treatment. Hepatic and renal impairment. Pregnancy and lactation. Patient Counselling May impair the ability to drive or operate machinery. Avoid intense or prolonged exposure to direct sunlight. Monitoring Parameters Monitor hepatic (prior and during treatment) and renal (during treatment) function, serum electrolytes, and visual and pancreatic function. Lactation: Not known if excreted in breast milk, a decision should be made whether to discontinue nursing or drug; weigh risk/benefit

Side Effect

>10% Visual changes (photophobia, color changes, increased or decreased visual acuity, or blurred vision occur in 21%) 1-10% Tachycardia, Hypertension, Hypotension, Vasodilation, Peripheral edema, Fever, Chills, Headache, Hallucinations, Dizziness, Rash, Pruritus, Photosensitizing skin reactions, Hypokalemia, Hypomagnesemia, Nausea, Vomiting, Abdominal pain, Diarrhea, Xerostomia, Thrombocytopenia, Alkaline phosphatase increased, Serum transaminases increased, ALT/AST increased, Cholestatic jaundice, ARF

Interaction

Increased prothrombin time w/ oral anticoagulants. May increase plasma concentrations of ciclosporin and tacrolimus, long-acting opiates (e.g. oxycodone, methadone), NSAIDs (e.g. ibuprofen, diclofenac), omeprazole, short-acting opiates (e.g. alfentanil, fentanyl). Decreased voriconazole plasma concentration and increased phenytoin plasma concentrations when used concomitantly. May increase plasma concentration w/ oral contraceptives. Potentially Fatal: May increase risk of QT prolongation or torsades de pointes w/ astemizole, cisapride, pimozide, quinidine, and terfenadine. May increase the risk of ergotism w/ ergot alkaloids (e.g. ergotamine and dihydroergotamine). May significantly increase plasma concentrations of sirolimus. Decreased plasma concentrations w/ rifampicin, carbamazepine, long-acting barbiturates (e.g. phenobarbital, mephobarbital), efavirenz (?400 mg once daily), ritonavir (?400 mg bid). Concomitant use may significantly increase rifabutin and decrease voriconazole plasma concentration.