Fungi are organisms that are present in different environments. While some of them are harmless, others can bring complications to human health.
This is the case of those that cause infections such as candidemia, invasive aspergillosis and esophageal candidiasis .
To combat and treat these problems, there are specific medications and, among them, the active ingredient Voriconazole.
- 1 What is Voriconazole?
- 2 What is the medicine Voriconazole for?
- 3 How does Voriconazole work?
- 4 Dosage: how to use Voriconazole?
- 5 How to dilute according to the package insert?
- 6 What are the side effects of Voriconazole?
- 7 Value: what is the price of Voriconazole and where to buy cheaper?
- 8 Does Voriconazole have SUS?
- 9 Is it approved by ANVISA?
- 10 How to budget Voriconazole?
What is Voriconazole?
Voriconazole is the active ingredient in some medicines. It is an antifungal drug, used to treat diseases caused by fungi, such as candidemia, invasive aspergillosis, esophageal candidiasis and others.
Its administration can be oral, in tablets, or intravenous, by infusion into the vein. The available presentations are: 50mg and 200mg coated tablet and 200mg lyophilized powder (for infusion).
It is manufactured by several companies, with Vfend – Commercialized by Pfizer – the reference medicine.
What is the medicine Voriconazole for?
The drug Voriconazole is used to fight and treat different infections caused by fungi. Among them, invasive aspergillosis, candidemia and esophageal candidiasis.
According to the package insert, among other infections, the drug is used to treat diseases:
Aspergillosis is a disease caused by fungi of the genus Aspergillus that, in general, affects the lungs. It is worth mentioning that these fungi are quite common in the environment, and, in general, are harmful when the person has low immunity.
The invasive type is the most serious of the disease and is characterized by the multiplication of the fungus in the lung, which later spreads to other organs through the bloodstream.
If there is no treatment, the problem can impair the functioning of some parts of the body.
Candidemia is an infection characterized by the presence of the Candida fungus in the bloodstream, the most common being C. albicans , but also with other very common types.
In general, it occurs in people whose immune system is weakened, which can make the infection even more severe. This is because the condition, by itself, is already serious, so if there is a weakness of the immune system, there are greater risks of the need for hospitalization and even mortality.
Esophageal candidiasis is an infection in the esophagus, caused by fungi of the genus Candida. It is characterized by the appearance of whitish plaques next to the organ mucosa.
In general, it appears more commonly in immunosuppressed patients, that is, those with reduced immune system activities.
How does Voriconazole work?
The active ingredient Voriconazole works by eliminating or reducing the growth of fungi that cause disease.
This, because it promotes the inhibition of the development of ergosterol, a substance that acts in the formation of the cell wall of fungi.
The effects of the medication start after a period of 1 to 2 hours after its administration.
Dosage: how to use Voriconazole?
Voriconazole has two routes of administration: oral and intravenous.
Their presentations are:
According to the package insert, it is recommended to take the medication at least 1 hour before or after a meal.
In general, it is recommended to start treatment intravenously for at least 7 days before starting oral administration. This, so that the body develops tolerance to the application through the mouth, of the medication.
The recommended maintenance dose for adults is:
|Patients weighing 40 kg or more||200mg every 12 hours|
|Patients under 40kg||100mg every 12 hours|
In children (2 to 12 years), the recommended dose is 200mg every 12 hours. Intravenous administration before oral is not recommended, that is, there is no loading dose.
Despite the indications, always follow the instructions of the doctor (a) responsible.
The Voriconazole solution for injection must be prepared and administered by a trained health professional.
According to the package insert, intravenous use should be done at a dose of a maximum of 3mg / kg per hour, for a period of 1 to 3 hours.
For use in adults , it is recommended, in the first applications of Voriconazole, to administer an attack dose.
Attack dose is one in which there is the objective of quickly achieving a certain concentration of medication in the body, so that the body can tolerate the application of other doses later.
The recommended dose, in the first 24 hours of treatment with Voriconazole, is 6 kg / mg every 12 hours.
After this period, the next doses should be adjusted following medical guidelines, according to each clinical picture.
For children (2 to 12 years old) and adolescents (12 to 14 years old, under 50 kg), the indicated attack dose, in the first 24 hours, is 9 mg / kg every 12 hours.
After that time, the recommendation is to apply 8mg / kg every 12 hours.
How to dilute according to the package insert?
In order to use the intravenous version of Voriconazole, it is necessary to dilute the injectable powder before application. For this, there are some steps, but that should only be done by professionals.
The first is to perform the reconstitution of the drug, that is, transform the drug from powder to liquid form.
For this, it is necessary to mix the contents of the Voriconazole vial with water for injections. The instructions are:
- Mix the contents of the vial together with 19mL of water for injections;
- Shake until a homogeneous solution is obtained.
After that, each reconstituted mL of the final solution contains 10mg of Voriconazole.
Then, the dilution process begins. In this step, it is necessary to add the reconstituted liquid to a diluent recommended by a health professional, such as Glucose 5% or Sodium chloride.
Once diluted, the solution is ready to be administered.
What are the side effects of Voriconazole?
Like other medicines, Voriconazole can cause side effects in some people.
According to the package leaflet, the most common ones found are:
- Swelling of the legs, foot and ankle (peripheral edema);
- Headache ;
- Visual disturbance;
- Fever ;
- Changes in liver test results;
- Diarrhea ;
Common reactions include:
- Sinusitis ;
- Agranulocytosis (reduction or absence of defense cells);
- Decrease in all blood cells (pancytopenia);
- Decrease in blood platelets (thrombocytopenia);
- Decrease in the body’s defense cells (leukopenia);
- Decrease in red blood cells (anemia);
- Hypokalaemia (decreased potassium in the blood);
- Hyponatremia (decreased sodium in the blood);
- Hypoglycemia (decrease in blood glucose);
- Insomnia ;
- Confused state;
- Fainting (syncope);
- Retinal hemorrhage;
- Change in heart rate;
- Pulmonary edema (accumulation of fluid in the lung);
- Inflammation of the lips (cheilitis);
- Inflammation of the gum (gingivitis);
- Abdominal pain;
- Change in skin color (jaundice);
- Skin peeling (exfoliative dermatitis);
- Hair loss ( alopecia );
- Reddish spots on the skin;
- Itching (itching);
- Back pain;
- Acute renal failure;
- Blood in the urine (haematuria);
- Chest pain ;
- Swelling of the face (edema);
- Tiredness (asthenia);
- Elevated creatinine in the blood.
The uncommon ones , however, which may occur, are:
- Pseudomembranous colitis (infection in the large intestine);
- Decreased bone marrow function;
- Allergic reaction;
- Swelling of the brain;
- Increase in blood cholesterol;
- Inflammation of the kidneys;
- Hives ;
- Inflammation of the duodenum;
- Increase of eosinophils in the blood (defense cells);
- Adrenal insufficiency;
- Balance disorders;
- Movement disorders;
- Peripheral nerve injuries;
- Decreased sensitivity;
- Change in taste;
- Diplopia (double vision);
- Blepharitis (inflammation of the eyelid);
- Hearing impairment;
- Thrombophlebitis (clot formation within an inflamed vein);
- Inflammation of the peritoneum;
- Inflammation of the stomach and small intestine;
- Inflammation of the tongue;
- Liver failure;
- Cholelithiasis (formation of stones in the gallbladder);
- Inflammation of the kidneys;
- Flu symptoms.
Rare reactions are:
- Clot formation in blood vessels;
- Hyperthyroidism (increased thyroid function);
- Nystagmus (involuntary movement of the eyes);
- Skin irritation;
- Psoriasis ;
- Ulcerations by the body;
- Angioedema (swelling of the deep parts of the skin);
- Corneal opacity;
- Severe flaking of the top layer of the skin;
- Blockage of the veins that stimulate the heart beat;
- Cardiac arrhythmia;
- Optic nerve disorders;
- Change in visual function;
- Guillain-Barré syndrome (disease that causes deterioration of peripheral nerves);
- Anaphylactoid reaction (severe allergic reaction).
Despite the reactions listed, it is worth remembering that each organism reacts differently to the use of the medication. That way, not all people will necessarily suffer from the side effects.
Value: what is the price of Voriconazole and where to buy cheaper?
The price of Voriconazole may vary according to the geographic region, establishment of purchase and brand suggested in the prescription.
There are different categories of the drug, including reference, generic and similar.
They can be found in physical pharmacies and online and, if there is a need to compare prices, it is possible to use the Consulta Remédios website , which indicates the values of medicines in several pharmacies in each region.
The options and prices are:
Reference drugs are those that originated the medication formula. Its effectiveness, safety and quality are scientifically proven and approved by Anvisa.
The reference for the active ingredient Voriconazole is Vfend, produced by Wyeth, a pharmaceutical industry.
Its price is, in general, found from *:
- Vfend 200mg, box with 1 vial – R $ 1,626;
- Vfend 200mg, box with 14 pills – R $ 6,299;
- Vfend 50mg, box with 50 pills – R $ 1,816.
* Prices consulted in March 2020. Prices may change.
Generic drugs are those that have the same active ingredient, dose, pharmaceutical form, indication and route of administration as the reference, but without the commercial nomenclature.
Thus, it is marketed by the name of the active ingredient.
Some generic options and values * of Voriconazole, are from:
- Voriconazole Glenmark 200mg, box of 10 capsules – R $ 690;
- Voriconazole Cristália 200mg, box with 14 pills – R $ 1,180;
- Voriconazole Cristália 200mg, box with 1 vial – R $ 890;
- Voriconazole Wyeth / Pfizer 200mg, box with 14 pills – R $ 4,353.
* Prices consulted in March 2020, values may change.
Similar are the drugs that have the same efficacy and effect as the reference, but with different excipients, for example.
Among Voriconazole’s similar options are:
- Vori Compressed ;
- Injectable Vori ;
- Veac ;
- Velenaxol ;
- Micend .
Does Voriconazole have SUS?
No . The active ingredient Voriconazole is not part of the National List of Essential Medicines (Rename), that is, the list of drugs distributed directly by SUS.
However, patients with a medical prescription and who are unable to afford the treatment can request the coverage of the medication by the State, in court.
In this case, it is necessary to file a lawsuit, presenting some documents such as medical report, exams and the budget in 3 different pharmacies.
Is it approved by ANVISA?
-Yeah . Voriconazole is registered with the National Health Surveillance Agency (ANVISA).
The reference medicine, that is, Vfend, had its first registration in 2002. The new and current registration was made in 2017 by Wyeth – pharmaceutical industry – and is valid until the year 2027.
How to budget Voriconazole?
In cases where SUS does not provide medication and the patient cannot afford the costs, there is the possibility of going to court and requesting coverage of treatment by the State.
For that, it is necessary to open a judicial process, presenting some documents. Between them:
- Medical report;
- Budget in 3 different pharmacies.
For the realization of the quotation, it is possible to obtain assistance in advising on the quotation of high-cost medications, which makes a personalized quote in a simple way.
Just click on the link , fill in the requested data and wait for the return.
Medicines, in general, help to fight diseases, be they serious or of low risk, and also in improving people’s well-being.
This is the case of Voriconazole, a drug administered intravenously and / or orally, used to treat fungal infections.
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