Voriconazole renal function

In patients who cannot tolerate voriconazole, amphotericin B can be used. Full doses (1 to 1.5 mg/kg/day) are generally recommended, with response measured by defervescence and radiographic clearing. The lipid-based formulations may be preferred as initial therapy in patients with marginal renal function or in patients receiving other nephrotoxic drugs. The optimal duration of treatment is unknown. 

Renal function impairment In patients with moderate or severe renal insufficiency (Ccr below 50 mL/min), accumulation of the IV vehicle, SBECD, occurs. Administer oral voriconazole to these patients, unless an assessment of the benefit/risk to the patient justifies the use of IV voriconazole. Closely monitor serum creatinine levels in these patients, and, if increases occur, consider changing to oral voriconazole therapy. 

Renal function impairment A pharmacokinetic study in subjects with renal failure undergoing hemodialysis showed that voriconazole is dialyzed with clearance of 121 mL/min. The IV vehicle, SBECD, is hemodialyzed with clearance of 55 mL/min. A 4-hour hemodialysis session does not remove a sufficient amount of voriconazole to warrant dose adjustment. 

Urinary tract, kidneys A retrospective study evaluated the renal function of 166 patients treated with voriconazole [28 ]. Decreased renal function (creatinine clearance <50 ml/min) was observed in 25.3% and 28.3% of the patients receiving intravenous or oral voriconazole, respectively. Previous diseases, decreased liver function and concomitant administration of other drugs were the strongest predictors of renal dysfunction. 

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