Vfend (Voriconazole)
Triazole Antifungal — Prescription Medication for Serious Fungal Infections
Vfend (voriconazole) is a broad-spectrum triazole antifungal medication used to treat life-threatening fungal infections, including invasive aspergillosis and candidemia. It works by inhibiting a key enzyme in fungal cell membrane synthesis, effectively killing or stopping the growth of pathogenic fungi. Vfend is available as film-coated tablets in 50 mg and 200 mg strengths and requires a prescription.
Quick Facts: Vfend
Key Takeaways
- Vfend is a first-line treatment for invasive aspergillosis and is used for serious Candida, Scedosporium, and Fusarium infections.
- Take tablets at least one hour before or after meals — food significantly reduces absorption.
- Visual disturbances (blurred vision, photophobia, color changes) are very common and usually transient, occurring within 30 minutes of dosing.
- Numerous critical drug interactions exist — always inform your doctor of all medications you are taking, including herbal supplements.
- Regular liver function monitoring is essential throughout treatment. Avoid sun exposure and use high-SPF sunscreen due to photosensitivity risk.
What Is Vfend and What Is It Used For?
Quick Answer: Vfend (voriconazole) is a prescription antifungal that treats life-threatening fungal infections by inhibiting ergosterol synthesis in fungal cell membranes. It is the first-line treatment for invasive aspergillosis and is also used for candidemia and infections caused by resistant or rare fungal species.
Vfend contains the active substance voriconazole, a second-generation triazole antifungal agent. It works by blocking the enzyme lanosterol 14-alpha-demethylase (CYP51), which is essential for producing ergosterol — a critical component of fungal cell membranes. Without ergosterol, fungal cells lose membrane integrity and die. This mechanism makes voriconazole effective against a broad spectrum of pathogenic fungi while having relatively low toxicity to human cells.
Vfend is approved for use in adults and children aged 2 years and older for the treatment of the following conditions:
- Invasive aspergillosis — A serious lung infection caused by Aspergillus species, most commonly affecting immunocompromised patients. Voriconazole is recommended as first-line therapy by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID).
- Candidemia — A bloodstream infection caused by Candida species in non-neutropenic patients (those without severely low white blood cell counts). This is a potentially fatal systemic fungal infection requiring prompt treatment.
- Fluconazole-resistant invasive Candida infections — Severe infections caused by Candida strains that do not respond to fluconazole, another commonly used antifungal. Voriconazole provides broader coverage against resistant strains, including C. krusei and some C. glabrata isolates.
- Serious Scedosporium infections — Rare but severe infections caused by Scedosporium apiospermum, a fungus that is intrinsically resistant to many antifungal agents. Voriconazole is one of the few agents with consistent activity against this organism.
- Serious Fusarium infections — Life-threatening infections caused by Fusarium species, which are notoriously difficult to treat. Voriconazole has demonstrated clinical efficacy where other antifungals have failed.
Vfend is also authorized for prophylaxis (preventive treatment) in patients who have undergone allogeneic hematopoietic stem cell transplantation and are at high risk of developing invasive fungal infections. Prophylactic use has been shown to reduce the incidence of breakthrough fungal infections in this vulnerable population.
This medication is intended exclusively for patients with worsening or potentially life-threatening fungal infections and should only be used under the supervision of a physician experienced in the management of invasive fungal diseases. The decision to initiate voriconazole therapy should ideally be based on microbiological culture and sensitivity testing, though empirical therapy may be started while awaiting results in critically ill patients.
What Should You Know Before Taking Vfend?
Quick Answer: Do not take Vfend if you are allergic to voriconazole or if you are taking certain medications including rifampicin, carbamazepine, high-dose efavirenz, sirolimus, ergot alkaloids, pimozide, quinidine, or St. John’s Wort. Inform your doctor about liver disease, heart conditions, or QT prolongation before starting treatment.
Contraindications
Do not use Vfend if you are allergic to voriconazole or any of the other ingredients in the tablets. It is critically important that you inform your doctor about all medications you are currently taking or have recently taken, including over-the-counter medicines and herbal supplements. The following medications must not be taken during treatment with Vfend due to the risk of serious or life-threatening interactions:
- Terfenadine and astemizol — antihistamines (risk of fatal cardiac arrhythmias)
- Cisapride — gastrointestinal motility agent (risk of QT prolongation)
- Pimozide — antipsychotic (risk of QT prolongation and cardiac arrest)
- Quinidine — antiarrhythmic (risk of QT prolongation)
- Ivabradine — for chronic heart failure (risk of bradycardia)
- Rifampicin — for tuberculosis (dramatically reduces voriconazole levels)
- Efavirenz at doses of 400 mg or more once daily — for HIV
- Carbamazepine — for seizures (potent CYP450 inducer)
- Phenobarbital — for seizures and severe insomnia
- Ergot alkaloids (ergotamine, dihydroergotamine) — for migraine (risk of ergotism)
- Sirolimus — immunosuppressant for transplant patients
- Ritonavir at doses of 400 mg or more twice daily — for HIV
- St. John’s Wort (Hypericum perforatum) — herbal supplement
- Naloxegol — for opioid-induced constipation
- Tolvaptan — for hyponatremia or polycystic kidney disease
- Lurasidone — for depression
- Finerenone — for chronic kidney disease
- Venetoclax — for chronic lymphocytic leukemia (CLL)
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before using Vfend if any of the following apply to you:
- You have previously had an allergic reaction to other azole antifungals (such as fluconazole, itraconazole, or posaconazole)
- You have or have had liver disease — your doctor may prescribe a lower dose and will monitor your liver function with regular blood tests
- You have a known heart muscle disease (cardiomyopathy), irregular heartbeat, slow heart rate, or an ECG abnormality called long QTc syndrome
Avoid all sunlight and sun exposure during Vfend treatment. Cover exposed areas of skin and use a high-SPF sunscreen, as the medication significantly increases photosensitivity. This effect may be amplified by other photosensitizing drugs such as methotrexate. These precautions also apply to children. If you develop sunburn, rash or blisters, or bone pain, inform your doctor immediately.
Long-term use of Vfend carries a small but documented risk of developing squamous cell carcinoma (skin cancer). Your doctor may refer you to a dermatologist for regular skin examinations, particularly if you require extended treatment courses. This risk appears to be cumulative and is more pronounced in patients who also develop phototoxic skin reactions.
Tell your doctor if you develop signs of adrenal insufficiency, which means the adrenal glands are not producing enough steroid hormones such as cortisol. Symptoms may include chronic fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain. Voriconazole can inhibit CYP3A4-mediated metabolism of corticosteroids, potentially leading to either cortisol excess or, upon withdrawal of exogenous steroids, adrenal crisis.
Also inform your doctor if you develop signs of Cushing’s syndrome, which indicates an excess of cortisol. Symptoms include weight gain, fat deposits between the shoulders (buffalo hump), rounded face, darkened skin on the abdomen, thighs, breasts, and arms, thin skin, easy bruising, elevated blood sugar, excessive hair growth, and excessive sweating.
Vfend should not be given to children under 2 years of age. Your doctor will monitor liver and kidney function throughout treatment by ordering regular blood tests.
Pregnancy and Breastfeeding
Vfend must not be taken during pregnancy unless specifically prescribed by your doctor, as it may cause harm to the unborn child. Animal studies have shown evidence of teratogenicity (birth defects) at therapeutic doses. Women of childbearing potential must use effective contraception during treatment. Contact your doctor immediately if you become pregnant while taking Vfend.
It is not known whether voriconazole is excreted in human breast milk. Breastfeeding is not recommended during treatment. If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, seek advice from your doctor before using this medicine.
Driving and Operating Machinery
Vfend commonly causes visual disturbances including blurred vision, altered color perception, and abnormal light sensitivity. These effects typically occur within 30 minutes of taking a dose. While experiencing any of these symptoms, you should not drive, operate tools, or use machinery. Inform your doctor if these visual changes persist or worsen.
Vfend tablets contain lactose. If you have been told by your doctor that you have an intolerance to certain sugars, contact your doctor before taking Vfend. The tablets contain less than 1 mmol (23 mg) sodium per tablet, meaning they are essentially sodium-free.
How Does Vfend Interact with Other Drugs?
Quick Answer: Vfend has numerous significant drug interactions because it is both a substrate and inhibitor of cytochrome P450 enzymes (CYP2C19, CYP2C9, and CYP3A4). Many commonly prescribed medications require dose adjustments or are completely contraindicated. Always provide your doctor with a complete medication list.
Voriconazole is extensively metabolized by the hepatic cytochrome P450 enzyme system and also inhibits several CYP isoforms. This dual role creates a complex pharmacokinetic interaction profile. Some medications can reduce voriconazole levels to sub-therapeutic concentrations, while voriconazole can dramatically increase blood levels of other drugs to potentially toxic concentrations.
Major Interactions (Avoid Co-administration)
The following interactions have been identified as clinically significant. Discuss with your doctor if you are taking any of these medications:
| Drug / Drug Class | Interaction | Clinical Significance |
|---|---|---|
| Ritonavir (low-dose, 100 mg twice daily) | Reduces voriconazole levels | Avoid unless benefit outweighs risk; monitor closely |
| Glasdegib (cancer therapy) | Increased glasdegib levels; QT prolongation risk | Frequent cardiac rhythm monitoring required |
| Rifabutin (tuberculosis) | Mutual interaction — reduces voriconazole, increases rifabutin | Avoid if possible; monitor blood levels and side effects |
| Phenytoin (epilepsy) | Reduces voriconazole levels; voriconazole increases phenytoin | Monitor phenytoin levels; voriconazole dose adjustment needed |
| Warfarin and anticoagulants | Significantly increased anticoagulant effect | Close INR monitoring required; dose reduction likely |
| Cyclosporine (transplant) | Markedly increased cyclosporine levels | Halve cyclosporine dose; monitor trough levels |
| Tacrolimus (transplant) | Markedly increased tacrolimus levels | Reduce tacrolimus to one-third dose; monitor levels |
Other Important Interactions Requiring Monitoring
The following medications may interact with Vfend, potentially requiring dose adjustments or additional monitoring:
- Sulfonylureas (tolbutamide, glipizide, glyburide) — increased hypoglycemia risk; monitor blood glucose
- Statins (atorvastatin, simvastatin) — increased risk of rhabdomyolysis; consider dose reduction
- Benzodiazepines (midazolam, triazolam) — prolonged sedation; dose reduction needed
- Omeprazole — increased omeprazole levels; halve the dose if on 40 mg or more
- Oral contraceptives — may cause nausea and menstrual irregularities
- Vinca alkaloids (vincristine, vinblastine) — increased neurotoxicity risk
- Tyrosine kinase inhibitors (axitinib, bosutinib, cabozantinib, ceritinib, cobimetinib, dabrafenib, dasatinib, nilotinib, sunitinib, ibrutinib, ribociclib) — increased toxicity risk
- Tretinoin — for leukemia treatment
- HIV protease inhibitors (indinavir and others) — mutual dose adjustments may be needed
- NNRTIs (efavirenz at low dose, delavirdine, nevirapine) — complex interaction
- Methadone — increased levels; monitor for QT prolongation
- Opioids (alfentanil, fentanyl, sufentanil, oxycodone, hydrocodone) — prolonged respiratory depression risk
- NSAIDs (ibuprofen, diclofenac) — increased exposure; monitor for toxicity
- Everolimus — dramatically increased levels; generally avoid co-administration
- Letermovir — for CMV prophylaxis post-transplant; mutual interaction
- Ivacaftor — for cystic fibrosis; dose reduction required
- Flucloxacillin — potential hepatotoxicity when combined
What Is the Correct Dosage of Vfend?
Quick Answer: For adults weighing 40 kg or more, the loading dose is 400 mg every 12 hours for the first 24 hours, followed by a maintenance dose of 200 mg twice daily. Dosing is weight-based, and your doctor may adjust the dose based on response and tolerability. Take tablets at least one hour before or after meals.
Always take Vfend exactly as your doctor has instructed. The dose depends on your body weight, the type and severity of infection, and how your liver and kidneys are functioning. Do not change your dose or stop treatment without consulting your doctor.
Adults (Including Elderly Patients)
| Phase | 40 kg or More | Under 40 kg |
|---|---|---|
| Loading dose (first 24 hours) | 400 mg every 12 hours | 200 mg every 12 hours |
| Maintenance dose | 200 mg twice daily | 100 mg twice daily |
Depending on your clinical response, your doctor may increase the maintenance dose to 300 mg twice daily. If you have mild to moderate liver impairment, your doctor may prescribe a reduced dose and will perform more frequent liver function monitoring.
Children and Adolescents
| Phase | 2 to <12 years & 12–14 years (<50 kg) | 12–14 years (≥50 kg) & >14 years |
|---|---|---|
| Loading dose (first 24 hours) | Treatment initiated as IV infusion | 400 mg every 12 hours |
| Maintenance dose | 9 mg/kg twice daily (max 350 mg twice daily) | 200 mg twice daily |
Tablets may only be given to children who are able to swallow tablets. For younger children or those unable to swallow, an oral suspension or IV formulation is available. Your doctor may increase or decrease the dose based on clinical response and therapeutic drug monitoring.
Take your tablet at least one hour before or one hour after a meal. Food significantly reduces the absorption of voriconazole from tablets. Swallow the tablet whole with water. Do not crush, chew, or split the tablet.
Missed Dose
It is important to take your Vfend tablets regularly at the same time each day to maintain consistent blood levels. If you miss a dose, take the next dose at its regularly scheduled time. Do not take a double dose to make up for a forgotten dose. Consistency in dosing is critical because the efficacy of voriconazole is closely linked to maintaining adequate blood concentrations above the minimum inhibitory concentration (MIC) for the target pathogen.
Overdose
If you take more Vfend than prescribed, or if someone else takes your tablets, seek medical advice immediately or go to the nearest emergency department. Bring the Vfend tablet packaging with you. Overdose may result in abnormal light sensitivity and intensification of the visual disturbances that are commonly associated with the medication. There is no specific antidote for voriconazole overdose; treatment is supportive. Voriconazole is hemodialyzable, meaning dialysis may help remove the drug from the blood in severe cases.
Stopping Treatment
Continue taking Vfend until your doctor tells you to stop. Do not discontinue treatment early, as your infection may not be fully resolved. Patients with compromised immune systems or severe infections may require long-term treatment to prevent recurrence. When treatment is stopped by your doctor, you should not notice any adverse withdrawal effects. However, premature discontinuation significantly increases the risk of relapse, which can be difficult to treat and may require more aggressive therapy.
What Are the Side Effects of Vfend?
Quick Answer: The most common side effects of Vfend include visual disturbances (affecting more than 1 in 10 patients), fever, rash, nausea, vomiting, diarrhea, headache, and elevated liver enzymes. Serious side effects requiring immediate medical attention include severe skin reactions, jaundice, and pancreatitis.
Like all medicines, Vfend can cause side effects, although not everybody gets them. Most side effects are mild to moderate and transient. However, some can be serious and require prompt medical attention.
- Severe skin rash with blistering or peeling
- Jaundice (yellowing of the skin or eyes) or changes in liver function blood tests
- Inflammation of the pancreas (severe upper abdominal pain radiating to the back)
Very Common
May affect more than 1 in 10 people
- Visual disturbances (blurred vision, altered color perception, photophobia, color blindness, halo vision, night blindness, flickering vision, visual aura, reduced visual acuity, floaters)
- Fever
- Skin rash
- Nausea, vomiting, diarrhea
- Headache
- Swollen arms and legs (peripheral edema)
- Abdominal pain
- Respiratory distress
- Elevated liver enzymes
Common
May affect up to 1 in 10 people
- Sinusitis, gum inflammation, chills, weakness
- Low blood cell counts (anemia, leukopenia, thrombocytopenia)
- Low blood sugar, low potassium, low sodium
- Anxiety, depression, confusion, agitation, insomnia, hallucinations
- Seizures, tremor, involuntary muscle movements, tingling, increased muscle tone, drowsiness, dizziness
- Eye hemorrhage
- Heart rhythm disturbances (tachycardia, bradycardia), fainting
- Low blood pressure, blood vessel inflammation (risk of blood clots)
- Acute respiratory distress, chest pain, facial swelling, pulmonary edema
- Constipation, indigestion, lip inflammation
- Jaundice, hepatitis, liver damage
- Rash with potential blistering and peeling, skin redness
- Itching, hair loss
- Back pain
- Kidney failure, blood in urine
- Sunburn or severe skin reactions after sun/light exposure
- Skin cancer (with long-term use)
Uncommon
May affect up to 1 in 100 people
- Flu-like symptoms, gastrointestinal inflammation, antibiotic-associated diarrhea
- Peritonitis (inflammation of the abdominal lining)
- Enlarged lymph nodes, bone marrow failure, eosinophilia
- Adrenal insufficiency, hypothyroidism
- Abnormal brain function, Parkinson-like symptoms, peripheral neuropathy
- Double vision, optic nerve damage, eye pain and inflammation
- Altered taste perception, hearing difficulties, tinnitus, vertigo
- Pancreatitis, duodenal inflammation, tongue swelling
- Liver enlargement, liver failure, gallbladder problems, gallstones
- Joint inflammation, superficial vein inflammation (with possible blood clots)
- Kidney inflammation, proteinuria, kidney damage
- Very rapid or irregular heartbeat, abnormal ECG
- Elevated cholesterol, elevated blood urea
- Severe allergic skin reactions including Stevens-Johnson syndrome, eczema
- Infusion site reactions, allergic or exaggerated immune responses
- Periostitis (inflammation of tissue surrounding bone)
Rare
May affect up to 1 in 1,000 people
- Hyperthyroidism (overactive thyroid)
- Hepatic encephalopathy (brain dysfunction from liver disease)
- Optic nerve atrophy, corneal opacity, involuntary eye movements
- Bullous photosensitivity (severe blistering sunburn reaction)
- Guillain-Barré syndrome (immune system attacks peripheral nerves)
- Life-threatening cardiac arrhythmias or conduction disturbances
- Anaphylaxis (life-threatening allergic reaction)
- Blood clotting disorders
- Toxic epidermal necrolysis (severe skin peeling), angioedema, psoriasis-like reactions
- Cutaneous lupus erythematosus (autoimmune skin condition)
Frequency not known: freckles and pigmentation spots have also been reported.
Because Vfend can affect the liver and kidneys, your doctor will monitor these organ functions through regular blood tests. Inform your doctor if you experience stomach pain or if your stool has an unusual consistency. Elevated liver enzymes are also seen more frequently in children compared to adults.
Sunburn or severe skin reactions after light exposure were more common in children. If you or your child develop skin changes, your doctor may refer you to a dermatologist for regular follow-up examinations.
How Should You Store Vfend?
Quick Answer: Store Vfend out of the sight and reach of children. No special storage conditions are required. Do not use after the expiry date on the packaging. Dispose of unused medicines through your pharmacy — do not discard via household waste or drains.
Keep this medicine out of the sight and reach of children at all times. Do not use Vfend after the expiry date stated on the label and carton. The expiry date refers to the last day of that month. No special storage conditions are required for Vfend film-coated tablets — they can be stored at room temperature.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help to protect the environment and prevent accidental ingestion by children or pets.
What Does Vfend Contain?
Quick Answer: The active substance is voriconazole (50 mg or 200 mg per tablet). Inactive ingredients include lactose monohydrate, pregelatinized starch, croscarmellose sodium, povidone, magnesium stearate, hypromellose, titanium dioxide (E171), and glycerol triacetate.
Each Vfend 50 mg film-coated tablet contains 50 mg of voriconazole. Each Vfend 200 mg film-coated tablet contains 200 mg of voriconazole.
The other ingredients that make up the tablet core are: lactose monohydrate, pregelatinized starch, croscarmellose sodium, povidone, and magnesium stearate. The film coating contains: hypromellose, titanium dioxide (E171), lactose monohydrate, and glycerol triacetate (triacetin).
Appearance and Pack Sizes
Vfend 50 mg film-coated tablets are white to off-white, round tablets marked “Pfizer” on one side and “VOR50” on the other. Vfend 200 mg film-coated tablets are white to off-white, capsule-shaped tablets marked “Pfizer” on one side and “VOR200” on the other.
Vfend is available in pack sizes of 2, 10, 14, 20, 28, 30, 50, 56, and 100 tablets. Not all pack sizes may be marketed in all countries. The marketing authorization holder is Pfizer Europe MA EEIG, Brussels, Belgium.
Frequently Asked Questions About Vfend
Vfend (voriconazole) is a prescription antifungal medication used to treat serious, potentially life-threatening fungal infections. Its primary uses include invasive aspergillosis (the leading cause of death from mold infections in immunocompromised patients), candidemia in non-neutropenic patients, fluconazole-resistant invasive Candida infections, and serious infections caused by Scedosporium and Fusarium species. It is also approved for prophylaxis in high-risk stem cell transplant recipients.
The most common side effects (affecting more than 1 in 10 patients) include visual disturbances such as blurred vision, altered color perception, and photophobia. These typically occur within 30 minutes of dosing and resolve spontaneously. Other very common side effects include fever, skin rash, nausea, vomiting, diarrhea, headache, peripheral edema, abdominal pain, breathing difficulties, and elevated liver enzymes. Most of these effects are mild to moderate and temporary.
No. Vfend tablets should be taken at least one hour before or one hour after a meal. This is because food significantly reduces the absorption of voriconazole from tablets, which could result in sub-therapeutic blood levels and treatment failure. The tablets should be swallowed whole with water — do not crush, chew, or split them.
Voriconazole affects the photoreceptor cells in the retina, specifically through inhibition of retinal enzymes. Visual disturbances including blurred vision, enhanced brightness, altered color perception, and photophobia typically appear within 30 minutes of taking a dose and usually resolve within 30 to 60 minutes. These effects tend to decrease in intensity with continued treatment as the body adapts. While disconcerting, they are generally not harmful and do not cause permanent damage to vision. However, you should not drive or operate machinery while experiencing these symptoms.
The duration of Vfend treatment varies depending on the type and severity of infection and your immune status. Treatment for invasive aspergillosis typically lasts 6 to 12 weeks but can extend to several months in patients with ongoing immunosuppression. For candidemia, treatment usually continues for at least 14 days after the last positive blood culture. Prophylactic use in transplant recipients may continue for several months. Never stop Vfend without your doctor’s guidance, as premature discontinuation can lead to relapse.
Regular monitoring is essential during Vfend treatment. Your doctor will order liver function tests (AST, ALT, bilirubin) at baseline and at regular intervals throughout therapy. Kidney function tests, electrolyte levels (especially potassium and magnesium), and complete blood counts are also monitored. Therapeutic drug monitoring (measuring voriconazole blood trough levels) is recommended by international guidelines to ensure effective drug concentrations and minimize toxicity. Target trough levels are generally 1–5.5 mg/L. Patients on long-term therapy should undergo regular dermatological assessments due to the risk of photosensitivity-related skin cancer.
References
- European Medicines Agency (EMA). Vfend — Summary of Product Characteristics. Last updated 2025. Available at: ema.europa.eu/en/medicines/human/EPAR/vfend
- Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1–e60. doi:10.1093/cid/ciw326
- Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24 Suppl 1:e1–e38.
- World Health Organization. WHO Model List of Essential Medicines — 23rd List (2023). Geneva: WHO; 2023.
- Denning DW, Ribaud P, Milpied N, et al. Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis. Clin Infect Dis. 2002;34(5):563–571.
- Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347(6):408–415.
- Ashbee HR, Barnes RA, Johnson EM, et al. Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother. 2014;69(5):1162–1176.
- U.S. Food and Drug Administration. Vfend Prescribing Information. Revised 2024. Available at: accessdata.fda.gov
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