Sirolimus* (CYP3A4 Inhibition) | Significantly Increased | Contraindicated |
Rifabutin* (CYP3A4 Inhibition) | Significantly Increased | Contraindicated |
Efavirenz (400 mg every 24 hours)† (CYP3A4 Inhibition) | Significantly Increased | Contraindicated |
Efavirenz (300 mg every 24 hours)† (CYP3A4 Inhibition) | Slight Increase in AUCτ | When voriconazole is coadministered with efavirenz, voriconazole oral maintenance dose should be increased to 400 mg every 12 hours and efavirenz should be decreased to 300 mg every 24 hours. |
High-dose Ritonavir (400 mg every 12 hours)†(CYP3A4 Inhibition) | No Significant Effect of Voriconazole on Ritonavir Cmax or AUCτ | Contraindicated because of significant reduction of voriconazole Cmax and AUCτ. |
Low-dose Ritonavir (100 mg every 12 hours)† | Slight Decrease in Ritonavir Cmax and AUCτ | Coadministration of voriconazole and low-dose ritonavir (100 mg every 12 hours) should be avoided (due to the reduction in voriconazole Cmax and AUCτ) unless an assessment of the benefit/risk to the patient justifies the use of voriconazole. |
Pimozide, Quinidine, Ivabradine (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Contraindicated because of potential for QT prolongation and rare occurrence of torsade de pointes. |
Ergot Alkaloids (CYP450 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Contraindicated |
Naloxegol (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased which may Increase the Risk of Adverse Reactions | Contraindicated |
Tolvaptan (CYP3A4 Inhibition) | Although Not Studied Clinically, Voriconazole is Likely to Significantly Increase the Plasma Concentrations of Tolvaptan | Contraindicated |
Venetoclax (CYP3A4 Inhibition) | Not studied In Vivo or In Vitro, but Venetoclax Plasma Exposure Likely to be Significantly Increased | Coadministration of voriconazole is contraindicated at initiation and during the ramp-up phase in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Refer to the venetoclax labeling for safety monitoring and dose reduction in the steady daily dosing phase in CLL/SLL patients. For patients with acute myeloid leukemia (AML), dose reduction and safety monitoring are recommended across all dosing phases when coadministering VFEND with venetoclax. Refer to the venetoclax prescribing information for dosing instructions. |
Lemborexant (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Avoid concomitant use of VFEND with lemborexant. |
Glasdegib (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Consider alternative therapies. If concomitant use cannot be avoided, monitor patients for increased risk of adverse reactions including QTc interval prolongation. |
Tyrosine kinase inhibitors (including but not limited to axitinib, bosutinib, cabozantinib, ceritinib, cobimetinib, dabrafenib, dasatinib, nilotinib, sunitinib, ibrutinib, ribociclib) (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Avoid concomitant use of VFEND. If concomitant use cannot be avoided, dose reduction of the tyrosine kinase inhibitor is recommended. Refer to the prescribing information for the relevant product. |
Lurasidone (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Voriconazole is Likely to Significantly Increase the Plasma Concentrations of Lurasidone | Contraindicated |
Cyclosporine* (CYP3A4 Inhibition) | AUCτ Significantly Increased; No Significant Effect on Cmax | When initiating therapy with VFEND in patients already receiving cyclosporine, reduce the cyclosporine dose to one-half of the starting dose and follow with frequent monitoring of cyclosporine blood levels. Increased cyclosporine levels have been associated with nephrotoxicity. When VFEND is discontinued, cyclosporine concentrations must be frequently monitored and the dose increased as necessary. |
Methadone‡ (CYP3A4 Inhibition) | Increased | Increased plasma concentrations of methadone have been associated with toxicity including QT prolongation. Frequent monitoring for adverse reactions and toxicity related to methadone is recommended during coadministration. Dose reduction of methadone may be needed. |
Fentanyl (CYP3A4 Inhibition) | Increased | Reduction in the dose of fentanyl and other long-acting opiates metabolized by CYP3A4 should be considered when coadministered with VFEND. Extended and frequent monitoring for opiate-associated adverse reactions may be necessary. |
Alfentanil (CYP3A4 Inhibition) | Significantly Increased | An increase in the incidence of delayed and persistent alfentanil-associated nausea and vomiting were observed when coadministered with VFEND. Reduction in the dose of alfentanil and other opiates metabolized by CYP3A4 (e.g., sufentanil) should be considered when coadministered with VFEND. A longer period for monitoring respiratory and other opiate-associated adverse reactions may be necessary. |
Oxycodone (CYP3A4 Inhibition) | Significantly Increased | Increased visual effects (heterophoria and miosis) of oxycodone were observed when coadministered with VFEND. Reduction in the dose of oxycodone and other long-acting opiates metabolized by CYP3A4 should be considered when coadministered with VFEND. Extended and frequent monitoring for opiate-associated adverse reactions may be necessary. |
NSAIDs§ including. ibuprofen and diclofenac (CYP2C9 Inhibition) | Increased | Frequent monitoring for adverse reactions and toxicity related to NSAIDs. Dose reduction of NSAIDs may be needed. |
Tacrolimus* (CYP3A4 Inhibition) | Significantly Increased | When initiating therapy with VFEND in patients already receiving tacrolimus, reduce the tacrolimus dose to one-third of the starting dose and follow with frequent monitoring of tacrolimus blood levels. Increased tacrolimus levels have been associated with nephrotoxicity. When VFEND is discontinued, tacrolimus concentrations must be frequently monitored and the dose increased as necessary. |
Phenytoin* (CYP2C9 Inhibition) | Significantly Increased | Frequent monitoring of phenytoin plasma concentrations and frequent monitoring of adverse effects related to phenytoin. |
Oral Contraceptives containing ethinyl estradiol and norethindrone (CYP3A4 Inhibition)† | Increased | Monitoring for adverse reactions related to oral contraceptives is recommended during coadministration. |
Prednisolone and other corticosteroids (CYP3A4 Inhibition) | In Vivo Studies Showed No Significant Effects of VFEND on Prednisolone Exposure Not Studied In vitro or In vivo for Other Corticosteroids, but Drug Exposure Likely to be Increased | No dosage adjustment for prednisolone when coadministered with VFEND [see Clinical Pharmacology (12.3)]. Monitor for potential adrenal dysfunction when VFEND is administered with other corticosteroids [See Warnings and Precautions (5.8)]. |
Warfarin* (CYP2C9 Inhibition) | Prothrombin Time Significantly Increased | If patients receiving coumarin preparations are treated simultaneously with voriconazole, the prothrombin time or other suitable anticoagulation tests should be monitored at close intervals and the dosage of anticoagulants adjusted accordingly. |
Other Oral Coumarin Anticoagulants (CYP2C9/3A4 Inhibition) | Not Studied In Vivo or In Vitro for other Oral Coumarin Anticoagulants, but Drug Plasma Exposure Likely to be Increased |
Ivacaftor (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased which may Increase the Risk of Adverse Reactions | Dose reduction of ivacaftor is recommended. Refer to the prescribing information for ivacaftor |
Eszopiclone (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased which may Increase the Sedative Effect of Eszopiclone | Dose reduction of eszopiclone is recommended. Refer to the prescribing information for eszopiclone. |
Omeprazole* (CYP2C19/3A4 Inhibition) | Significantly Increased | When initiating therapy with VFEND in patients already receiving omeprazole doses of 40 mg or greater, reduce the omeprazole dose by one-half. The metabolism of other proton pump inhibitors that are CYP2C19 substrates may also be inhibited by voriconazole and may result in increased plasma concentrations of other proton pump inhibitors. |
Other HIV Protease Inhibitors (CYP3A4 Inhibition) | In Vivo Studies Showed No Significant Effects on Indinavir Exposure | No dosage adjustment for indinavir when coadministered with VFEND. |
| In Vitro Studies Demonstrated Potential for Voriconazole to Inhibit Metabolism (Increased Plasma Exposure) | Frequent monitoring for adverse reactions and toxicity related to other HIV protease inhibitors. |
Other NNRTIs¶ (CYP3A4 Inhibition) | A Voriconazole-Efavirenz Drug Interaction Study Demonstrated the Potential for Voriconazole to Inhibit Metabolism of Other NNRTIs (Increased Plasma Exposure) | Frequent monitoring for adverse reactions and toxicity related to NNRTI. |
Tretinoin (CYP3A4 Inhibition) | Although Not Studied, Voriconazole may Increase Tretinoin Concentrations and Increase the Risk of Adverse Reactions | Frequent monitoring for signs and symptoms of pseudotumor cerebri or hypercalcemia. |
Midazolam (CYP3A4 Inhibition) | Significantly Increased | Increased plasma exposures may increase the risk of adverse reactions and toxicities related to benzodiazepines. |
Other benzodiazepines including triazolam and alprazolam (CYP3A4 Inhibition) | In Vitro Studies Demonstrated Potential for Voriconazole to Inhibit Metabolism (Increased Plasma Exposure) | Refer to drug-specific labeling for details. |
HMG-CoA Reductase Inhibitors (Statins) (CYP3A4 Inhibition) | In Vitro Studies Demonstrated Potential for Voriconazole to Inhibit Metabolism (Increased Plasma Exposure) | Frequent monitoring for adverse reactions and toxicity related to statins. Increased statin concentrations in plasma have been associated with rhabdomyolysis. Adjustment of the statin dosage may be needed. |
Dihydropyridine Calcium Channel Blockers (CYP3A4 Inhibition) | In Vitro Studies Demonstrated Potential for Voriconazole to Inhibit Metabolism (Increased Plasma Exposure) | Frequent monitoring for adverse reactions and toxicity related to calcium channel blockers. Adjustment of calcium channel blocker dosage may be needed. |
Sulfonylurea Oral Hypoglycemics (CYP2C9 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Frequent monitoring of blood glucose and for signs and symptoms of hypoglycemia. Adjustment of oral hypoglycemic drug dosage may be needed. |
Vinca Alkaloids (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Frequent monitoring for adverse reactions and toxicity (i.e., neurotoxicity) related to vinca alkaloids. Reserve azole antifungals, including voriconazole, for patients receiving a vinca alkaloid who have no alternative antifungal treatment options. |
Everolimus (CYP3A4 Inhibition) | Not Studied In Vivo or In Vitro, but Drug Plasma Exposure Likely to be Increased | Concomitant administration of voriconazole and everolimus is not recommended. |