Voriconazole (Vfend), a derivative of fluconazole, is
a second-generation triazole that has improved antifun-gal activity against Aspergillus and Fusarium spp., P. boydii, Penicillium marneffei, and
fluconazole-resistant Candida spp.
Like fluconazole, voriconazole has high oral
bioavailability and good cerebrospinal fluid pene-tration, but unlike
fluconazole, it undergoes extensive hepatic metabolism and is highly protein
bound. No sig-nificant amount of bioactive drug is excreted into the urine.
Dosage reduction is necessary with severe he-patic insufficiency but not with
Significant drug interactions
include cyclosporins (increased cyclosporine levels), phenytoin, rifampin, and
rifabutin (decreased voriconazole levels). Because of its low toxicity profile,
this drug may gain importance in the chronic treatment of infections with
invasive di-morphic fungi and resistant Candida