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Vfend Information

Introduction

Vfend (voriconazole) is an antifungal medication indicated for the treatment of serious invasive fungal infections. It belongs to the triazole class of antifungals and is approved for use in adult patients in Hong Kong. The drug is manufactured by Pfizer and other licensed producers worldwide. In addition to its primary indication for invasive aspergillosis, Vfenter is also used to treat infections caused by Candida species and certain rare molds.

What is Vfend?

Vfend is a commercial formulation of the active compound voriconazole. It is classified as a systemic triazole antifungal. Voriconazole was first developed in the late 199s and received regulatory approval in the United States and the European Union in 2002. Pfizer introduced the brand name Vfend for the oral tablets and intravenous solution. The medication is available in 200 mg tablets and as a 200 mg/100 mL intravenous infusion.

How Vfend Works

Voriconazole inhibits fungal cytochrome P450‑dependent enzyme 14‑α‑demethylase, an essential step in ergosterol synthesis. Ergosterol is a key component of fungal cell membranes; its depletion leads to increased membrane permeability and ultimately cell death. The inhibition is selective for fungal enzymes, which accounts for the drug’s broad spectrum against Aspergillus, Candida, and several filamentous fungi. After oral administration, voriconazole is rapidly absorbed, reaching peak plasma concentrations within 2 hours. The drug has a nonlinear pharmacokinetic profile, a half‑life of 6 hours in most adults, and is primarily metabolized by hepatic CYP2C19, CYP2C9, and CYP3A4 isoenzymes.

Conditions Treated with Vfend

• Invasive Aspergillosis – The most frequent indication; voriconazole is superior to amphotericin B in clinical trials and is recommended as first‑line therapy by the Infectious Diseases Society of America (IDSA).
• Invasive Candidiasis (excluding Candida krusei and Candida glabrata infections) – Used when fluconazole resistance is suspected or when the patient cannot tolerate azole‑based regimens.
• Scedosporium and Fusarium infections – Voriconazole is one of the few agents with documented activity against these rare, often drug‑resistant molds.
• Otitis media and mastoiditis caused by Aspergillus spp. – Oral therapy may be employed after surgical debridement.

In Hong Kong, the incidence of invasive aspergillosis has risen among immunocompromised populations, including bone‑marrow transplant recipients and patients receiving prolonged corticosteroid therapy. Early, appropriate therapy with voriconazole improves survival rates and reduces hospital stay.

Who is Vfend For?

• Adults with confirmed invasive aspergillosis – especially those with hematologic malignancies, organ transplantation, or prolonged neutropenia.
• Patients with invasive candidiasis who are intolerant to fluconazole or who have isolates showing reduced susceptibility.
• Individuals with rare mold infections (e.g., Scedosporium, Fusarium) when susceptibility testing supports voriconazole use.
• Patients requiring oral step‑down therapy after initial intravenous control of a severe infection.

Contra‑indications include known hypersensitivity to voriconazole, severe hepatic impairment (Child‑Pugh C), and concurrent use of contraindicated drugs such as rifampicin or certain antiepileptics (e.g., carbamazepine).

Risks, Side Effects, and Interactions

Common

• Visual disturbances (color‑vision changes, photopsia) – transient, occurring in ~30 % of patients.
• Elevated liver enzymes (ALT, AST) – usually mild and reversible with dose adjustment.
• Nausea, vomiting, abdominal pain – gastrointestinal upset common within the first week.

Rare

• Severe photosensitivity reactions (phototoxic dermatitis).
• Hallucinations or other central‑nervous‑system effects, particularly in patients with renal impairment.
• Thrombocytopenia or neutropenia – more frequent in patients receiving concomitant chemotherapy.

Serious

• Hepatotoxicity leading to clinically significant hepatitis; liver function should be monitored weekly.
• Cardiac arrhythmias, including QT‑prolongation, especially when combined with other QT‑prolonging agents.
• Stevens‑Johnson syndrome or toxic epidermal necrolysis – rare but life‑threatening skin reactions.

Drug–Drug Interactions

• CYP450 inducers (rifampicin, carbamazepine, phenytoin) markedly reduce voriconazole concentrations; avoidance or alternative therapy is recommended.
• CYP450 inhibitors (ketoconazole, itraconazole, protease inhibitors) increase voriconazole levels and may require dose reduction.
• Statins (particularly simvastatin) – increased risk of myopathy; consider switching to pravastatin or rosuvastatin.
• Immunosuppressants (cyclosporine, tacrolimus) – voriconazole raises their plasma concentrations; therapeutic drug monitoring is essential.

Patients should disclose all concomitant medications, herbal supplements, and over‑the‑counter products to their healthcare provider before starting Vfend.

Practical Use: Dosing, Missed Dose, Overdose

• Loading dose (oral): 400 mg (two 200 mg tablets) every 12 hours for the first 24 hours (total of two doses).
• Maintenance dose (oral): 200 mg every 12 hours thereafter. Adjustments are needed for body weight < 40 kg, hepatic impairment, or when interacting drugs are present.
• Intravenous dosing: 6 mg/kg every 12 hours after a loading dose of 6 mg/kg every 12 hours for the first 24 hours.

Missed dose – Take the forgotten dose as soon as remembered if it is at least 6 hours before the next scheduled dose. Otherwise, skip the missed dose and resume the regular schedule; do not double‑dose.

Overdose – Symptoms may include severe nausea, vomiting, visual changes, and hepatic dysfunction. Seek immediate medical attention. Supportive care and monitoring of liver function are the mainstays of management; there is no specific antidote.

Precautions – Take tablets with food or a full glass of water to improve absorption. Avoid grapefruit juice, which can increase voriconazole exposure. Alcohol should be limited, as both agents are hepatically metabolized. Patients with renal dysfunction do not require dose adjustment for the oral formulation, but the intravenous formulation contains cyclodextrin, which can accumulate in severe renal failure; alternative therapy is advised.

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FAQ

• Can Vfend be taken with antacids?
  Voriconazole absorption is not significantly affected by antacids containing aluminum or magnesium. However, taking the medication with a full glass of water and food is recommended to minimise gastrointestinal upset.

• What is the recommended storage condition for voriconazole tablets?
  Store tablets at controlled room temperature (15‑30 °C) in a dry place, protected from direct sunlight and moisture. Do not refrigerate; prolonged exposure to humidity can degrade the active ingredient.

• Does voriconazole have a black‑box warning?
  Yes. The FDA and HK regulatory agencies highlight the risk of severe hepatotoxicity, visual disturbances, and photosensitivity. Regular liver‑function testing and avoidance of excessive sun exposure are advised.

• Is therapeutic drug monitoring (TDM) necessary for all patients?
  While routine TDM is not mandatory for every individual, it is strongly recommended for patients receiving prolonged therapy, those with hepatic impairment, or when drug–drug interactions are likely. Target trough concentrations of 1–5 µg/mL are generally considered therapeutic.

• How does voriconazole differ from fluconazole?
  Voriconazole has a broader spectrum, covering Aspergillus and many resistant molds, whereas fluconazole is mainly active against Candida spp. Voriconazole also exhibits higher potency but carries a greater risk of hepatotoxicity and visual side effects.

• Can I travel internationally with my voriconazole supply?
  Yes, provided you carry a valid prescription copy and the medication is in its original packaging. Some countries may require a medical certificate; it is advisable to check the specific import regulations of the destination beforehand.

• What inactive ingredients are present in Vfend tablets?
  The tablets contain lactose monohydrate, microcrystalline cellulose, povidone, magnesium stearate, and colloidal silicon dioxide. Patients with severe lactose intolerance should discuss alternatives with their clinician.

• Are there known genetic factors that affect voriconazole metabolism?
  Polymorphisms in the CYP2C19 gene markedly influence plasma levels. Poor metabolizers may experience higher exposures and increased toxicity, while ultra‑rapid metabolizers may have subtherapeutic concentrations. Genotype‑guided dosing is emerging in specialist centres.

• Does voriconazole interact with hormonal contraceptives?
  Voriconazole can increase plasma concentrations of estrogen‑containing contraceptives, potentially raising the risk of side effects such as nausea or thromboembolism. However, efficacy of contraception is not reduced; no change in contraceptive method is required.

• Is there a pediatric formulation of voriconazole available in Hong Kong?
  Pediatric dosing is typically based on weight‑adjusted oral suspension or intravenous preparation, but Vfend tablets are not approved for children under 12 years in Hong Kong. Consult a pediatric infectious disease specialist for appropriate formulation and dosing.

Glossary

Cytochrome P450 (CYP) enzymes

A family of liver enzymes that metabolise many drugs. Voriconazole is primarily processed by CYP2C19, CYP2C9, and CYP3A4.

Therapeutic drug monitoring (TDM)

Measurement of drug concentrations in blood to ensure levels stay within a target range, optimizing efficacy while minimizing toxicity.

Phototoxicity

An adverse skin reaction triggered or worsened by exposure to ultraviolet light, manifested as redness, burning, or rash after drug intake.

QT‑prolongation

Extension of the heart’s electrical repolarisation interval on an ECG, which can predispose to dangerous arrhythmias such as torsades de pointes.

⚠️ Disclaimer

The information provided about Vfend is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Vfend for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.