Voriconazole

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026

Voriconazole is a second-generation triazole antifungal used as first-line therapy for invasive aspergillosis and for serious infections caused by Candida, Scedosporium, and Fusarium species. It is available as oral tablets, an oral suspension, and an intravenous formulation, with high oral bioavailability. Because it is extensively metabolized by hepatic cytochrome P450 enzymes and shows nonlinear, saturable pharmacokinetics, drug interactions and interpatient variability are clinically significant and often require therapeutic drug monitoring.

Read the sources → Compare profiles

Publication status

Exploratory record, not a reviewed medical publication.

See the editorial and medical-review policies for the publication gate.

This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.

In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Voriconazole is a second-generation triazole antifungal used as first-line therapy for invasive aspergillosis and for serious infections caused by Candida, Scedosporium, and Fusarium species. NutriStack rates the supporting evidence as strong. Common adult dosing is IV loading dose 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg IV every 12 hours; oral maintenance 200 mg every 12 hours (may increase to 300 mg every 12 hours) for patients 40 kg or more, or 100 mg every 12 hours (up to 150 mg every 12 hours) for patients under 40 kg. Doses are individualized and frequently guided by trough therapeutic drug monitoring (target trough roughly 1 to 5.5 mg/L)., though a prescriber sets the actual dose. With long-term use it can deplete potassium, magnesium. This profile indexes 4 sources.

What it's good for

First-line treatment of invasive aspergillosis²
Treatment of candidemia in non-neutropenic patients and other deep tissue Candida infections
Treatment of esophageal candidiasis
Treatment of serious infections caused by Scedosporium apiospermum and Fusarium species

What to watch for

Visual disturbances (blurred vision, altered or enhanced visual perception, photophobia, color vision changes)
Elevated liver enzymes and hepatotoxicity
Photosensitivity and increased risk of skin cancer with long-term use
Hypersensitivity to voriconazole or other azole antifungals^1,2
Coadministration with CYP3A4 substrates that can cause QT prolongation (terfenadine, astemizole, cisapride, pimozide, quinidine)

The bottom line

Evidence rating strong. Most-documented uses: first-line treatment of invasive aspergillosis, treatment of candidemia in non-neutropenic patients and other deep tissue candida infections, treatment of esophageal candidiasis. 4 sources indexed (2002–2021), with 0 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Voriconazole inhibits the fungal cytochrome P450-dependent enzyme lanosterol 14-alpha-demethylase (encoded by ERG11/CYP51), which catalyzes a key step in the biosynthesis of ergosterol, the principal sterol of the fungal cell membrane. Blocking this enzyme depletes ergosterol and causes accumulation of toxic 14-alpha-methylated sterol precursors, disrupting membrane structure and function and inhibiting fungal growth. It is more selective for fungal than mammalian P450 enzymes, though its inhibition of human CYP2C19, CYP2C9, and CYP3A4 underlies many of its drug interactions.^4,1

Class

Triazole antifungal

Absorption

Best on an empty stomach

Dosing

Dosing & protocol.

Common range

IV loading dose 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg IV every 12 hours; oral maintenance 200 mg every 12 hours (may increase to 300 mg every 12 hours) for patients 40 kg or more, or 100 mg every 12 hours (up to 150 mg every 12 hours) for patients under 40 kg. Doses are individualized and frequently guided by trough therapeutic drug monitoring (target trough roughly 1 to 5.5 mg/L).

Recommended form

Oral tablet or IV infusion; oral doses taken at least 1 hour before or 1 hour after a meal

Oral bioavailability is high (about 96 percent) but is reduced when taken with food, especially high-fat meals. Voriconazole should be taken at least 1 hour before or 1 hour after a meal to optimize absorption. Absorption is not pH-dependent, so it does not require gastric acid.

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

Potassium

Moderate

Hypokalemia is a recognized adverse effect listed in voriconazole prescribing information and reported in clinical use. It commonly arises in the context of seriously ill antifungal-treated patients, frequently alongside concurrent nephrotoxic or potassium-wasting agents (for example amphotericin B or loop diuretics). Low potassium is clinically important because voriconazole prolongs the QT interval, and hypokalemia compounds the risk of torsades de pointes.

Replace Potassium chloride (only under clinician guidance with monitoring; do not self-supplement potassium)Monitor Serum potassiumOnset Days to weeks during a course of therapy; risk is greatest in critically ill patients and those on concomitant potassium-depleting drugs.

Magnesium

Mild

Hypomagnesemia is reported during voriconazole therapy, often co-occurring with hypokalemia and frequently driven by concurrent therapies such as amphotericin B, proton pump inhibitors, or critical illness rather than a direct, well-characterized depletion mechanism of voriconazole itself. Because low magnesium impairs correction of potassium and independently increases QT-prolongation and arrhythmia risk, it is relevant to monitor during treatment.

Replace Magnesium (oral repletion such as magnesium glycinate, or IV magnesium sulfate in the inpatient setting; under clinician guidance)Monitor Serum magnesiumOnset Days to weeks during therapy, particularly with co-administered magnesium-wasting agents.

Full Voriconazole depletion and interaction guide →

Safety

Full safety detail.

Side effects

Visual disturbances (blurred vision, altered or enhanced visual perception, photophobia, color vision changes)
Elevated liver enzymes and hepatotoxicity
Photosensitivity and increased risk of skin cancer with long-term use
Skin rash, including rare severe reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
QT interval prolongation
Visual and auditory hallucinations
Nausea, vomiting, and headache
Peripheral neuropathy with prolonged therapy
Fluoride excess and periostitis with long-term use
Infusion-related reactions with IV administration

Contraindications

Hypersensitivity to voriconazole or other azole antifungals^1,2
Coadministration with CYP3A4 substrates that can cause QT prolongation (terfenadine, astemizole, cisapride, pimozide, quinidine)
Coadministration with potent CYP3A4 inducers (rifampin, rifabutin, carbamazepine, long-acting barbiturates, St. John's wort) that markedly lower voriconazole levels
Coadministration with sirolimus, efavirenz (standard doses), ergot alkaloids, ritonavir (high dose), or naloxegol
IV formulation use in moderate to severe renal impairment due to accumulation of the cyclodextrin vehicle (use caution)²

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Randomized controlled trials

1Therapeutic drug monitoring of voriconazole: a prospective randomized controlled trialPMIDPark WB, Kim NH, Kim KH, et al. · Clinical Infectious Diseases · 2012
Routine therapeutic drug monitoring reduced drug discontinuation due to adverse events and improved treatment response compared with no monitoring.
2Voriconazole versus amphotericin B for primary therapy of invasive aspergillosisPMIDHerbrecht R, Denning DW, Patterson TF, et al. · New England Journal of Medicine · 2002
Initial therapy with voriconazole led to better responses (52.8 percent vs 31.6 percent) and improved survival compared with amphotericin B in invasive aspergillosis.

Reviews & position papers

3Clinical pharmacokinetics and pharmacodynamics of voriconazolePMIDTheuretzbacher U, Ihle F, Derendorf H · Clinical Pharmacokinetics · 2006
Voriconazole shows nonlinear pharmacokinetics due to saturable metabolism, with CYP2C19 polymorphisms contributing to large interpatient exposure variability.

Reference material

4VFEND (voriconazole) US Prescribing InformationPfizer Inc. · FDA Label · 2021
Voriconazole acts primarily by inhibiting fungal cytochrome P450-mediated 14-alpha-lanosterol demethylation, an essential step in ergosterol biosynthesis.

FAQ

Common questions.

Quick answers about Voriconazole, drawn from the data on this page.

What is Voriconazole?

Voriconazole is a second-generation triazole antifungal used as first-line therapy for invasive aspergillosis and for serious infections caused by Candida, Scedosporium, and Fusarium species. It is available as oral tablets, an oral suspension, and an intravenous formulation, with high oral bioavailability. Because it is extensively metabolized by hepatic cytochrome P450 enzymes and shows nonlinear, saturable pharmacokinetics, drug interactions and interpatient variability are clinically significant and often require therapeutic drug monitoring.

What is Voriconazole used for?

Commonly cited benefits of Voriconazole include: First-line treatment of invasive aspergillosis; Treatment of candidemia in non-neutropenic patients and other deep tissue Candida infections; Treatment of esophageal candidiasis; Treatment of serious infections caused by Scedosporium apiospermum and Fusarium species. NutriStack rates the overall evidence as strong.

What is a typical dose of Voriconazole?

A typical adult dose of Voriconazole is IV loading dose 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg IV every 12 hours; oral maintenance 200 mg every 12 hours (may increase to 300 mg every 12 hours) for patients 40 kg or more, or 100 mg every 12 hours (up to 150 mg every 12 hours) for patients under 40 kg. Doses are individualized and frequently guided by trough therapeutic drug monitoring (target trough roughly 1 to 5.5 mg/L).. The commonly recommended form is Oral tablet or IV infusion; oral doses taken at least 1 hour before or 1 hour after a meal. These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Voriconazole?

Reported side effects include visual disturbances (blurred vision, altered or enhanced visual perception, photophobia, color vision changes), elevated liver enzymes and hepatotoxicity, photosensitivity and increased risk of skin cancer with long-term use, skin rash, including rare severe reactions (stevens-johnson syndrome, toxic epidermal necrolysis), qt interval prolongation, visual and auditory hallucinations. This is educational information; check with a healthcare professional before use.

How strong is the evidence for Voriconazole?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

Use this with your stack

Voriconazole in NutriStack.

Add it to your stack, see how it interacts with everything else you take, and get a Stack Score that updates the moment it does.

Download on the App Store → Read the methodology