Voriconazole Milpharm 50 mg film-coated tablets – patient leaflet, side effects, dosage

1. What Voriconazole is and what it is used for

Voriconazole film-coated tablet contains the active substance voriconazole. Voriconazole is an antifungal medicine. It works by killing or stopping the growth of the fungi that cause infections.

It is used for the treatment of patients (adults and children over the age of 2) with: • Invasive aspergillosis (a type of fungal

infection due to Aspergillus sp), • Candidaemia (another type of fungal

infection due to Candida sp) in non-neutropenic patients (patients without abnormally low white blood cells count), • Serious invasive Candida sp.

infections when the fungus is resistant to fluconazole (another antifungal medicine),

• Serious fungal infections caused by

  Scedosporium sp. or Fusarium sp. (two different species of fungi).

Voriconazole is intended for patients with worsening, possibly life-threatening, fungal infections.

Prevention of fungal infections in high risk bone marrow transplant recipients. This product should only be taken under the supervision of a doctor.

2. What you need to know before you take Voriconazole

Do not take Voriconazole

If you are allergic to voriconazole or any of the other ingredients of this medicine (listed in section 6).

It is very important that you inform your doctor or pharmacist if you are taking or have taken any other medicines, even those that are obtained without a prescription, or herbal medicines.

The medicines in the following list must not be taken during your course of Voriconazole treatment:

• Terfenadine (used for allergy)
• Astemizole (used for allergy)

• Cisapride (used for stomach problems) • Pimozide (used for treating mental

  illness)

• Quinidine (used for irregular heart beat) • Ivabradine (used for symptoms of

  chronic heart failure)

  • Rifampicin (used for treating

    tuberculosis)

  • Efavirenz (used for treating HIV)

    in doses of 400 mg and above once daily

  • Carbamazepine (used to treat

    seizures)

  • Phenobarbital (used for severe

    insomnia and seizures) • Ergot alkaloids (e.g., ergotamine,

    dihydroergotamine; used for migraine)

  • Sirolimus (used in transplant

    patients)

• Ritonavir (used for treating HIV) in doses

  of 400 mg and more twice daily • St. John’s Wort (herbal supplement) • Naloxegol (used to treat constipation

  specifically caused by pain medicines, called opioids, (e.g., morphine, oxycodone, fentanyl, tramadol, codeine)) • Tolvaptan (used to treat hyponatremia

  (low levels of sodium in your blood) or to slow kidney function decline in patients with polycystic kidney disease) • Lurasidone (used to treat depression) • Finerenone (used to treat chronic kidney

  disease)

• Eplerenone (used to treat heart and/or

  blood vessel problems)

• Voclosporin (used to treat immune

  disorders)

• Venetoclax (used to treat patients with

  chronic lymphocytic leukaemia-CLL) Warnings and precautions

Talk to your doctor, pharmacist or nurse before taking Voriconazole if:

• you have had an allergic reaction to

  other azoles.

• you are suffering from, or have ever

  suffered from liver disease. If you have liver disease, your doctor may prescribe a lower dose of Voriconazole. Your doctor should also monitor your liver function while you are being treated with Voriconazole by doing blood tests. • you are known to have cardiomyopathy,

  irregular heart beat, slow heart rate or an abnormality of electrocardiogram (ECG) called ‘long QTc syndrome’.

You should avoid any sunlight and sun exposure while being treated. It is important to cover sun exposed areas of skin and use sunscreen with high sun protection factor (SPF), as an increased sensitivity of skin to the sun’s UV rays can occur. This may be further increased by other medicines that sensitise the skin to sunlight, like methotrexate. These precautions are also applicable to children.

While being treated with Voriconazole: • Tell your doctor immediately if you

develop

• sunburn
• severe skin rash or blisters • bone pain

If you develop skin disorders as described above, your doctor may refer you to a dermatologist, who after consultation may decide that it is important for you to be seen on a regular basis. There is a small chance that skin cancer could develop with long-term use of Voriconazole.

If you develop signs of ‘adrenal insufficiency’ where the adrenal glands do not produce adequate amounts of certain steroid hormones such as cortisol which may lead to symptoms such as: chronic, or long lasting fatigue, muscle weakness, loss of appetite, weight loss, abdominal pain, please tell your doctor.

If you develop signs of ‘Cushing’s syndrome’ where the body produces too much of the hormone cortisol which may lead to symptoms such as: weight gain, fatty hump between the shoulders, a rounded face, darkening of the skin on the stomach, thighs, breasts, and arms, thinning skin, bruising easily, high blood sugar, excessive hair growth, excessive sweating, please tell your doctor.

Your doctor should monitor the function of your liver and kidney by doing blood tests.

Children and adolescents

Voriconazole should not be given to children younger than 2 years of age.

Other medicines and Voriconazole

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines, including those that are obtained without a prescription. Some medicines, when taken at the same time as Voriconazole, may affect the way Voriconazole works or Voriconazole may affect the way they work.

Tell your doctor if you are taking the following medicine, as treatment with Voriconazole at the same time should be avoided if possible:

• Ritonavir (used for treating HIV) in doses of 100 mg twice daily

• Glasdegib (used for treating cancer) – if you need to use both drugs your doctor will monitor your heart rhythm frequently Tell your doctor if you are taking either of the following medicines, as treatment with Voriconazole at the same time should be avoided if possible, and a dose adjustment of voriconazole may be required: • Rifabutin (used for treating tuberculosis).

  If you are already being treated with rifabutin your blood counts and side effects to rifabutin will need to be monitored.

• Phenytoin (used to treat epilepsy). If you are already being treated with phenytoin your blood concentration of phenytoin will need to be monitored during your treatment with Voriconazole and your dose may be adjusted.

Tell your doctor if you are taking any of the following medicines, as a dose adjustment or monitoring may be required to check that the medicines and/ or Voriconazole are still having the desired effect:

• Warfarin and other anticoagulants (e.g., phenprocoumon, acenocoumarol; used to slow down clotting of the blood) • Ciclosporin (used in transplant patients) • Tacrolimus (used in transplant patients) • Sulfonylureas (e.g., tolbutamide, glipizide, and glyburide) (used for diabetes) • Statins (e.g., atorvastatin, simvastatin)

  (used for lowering cholesterol) • Benzodiazepines (e.g midazolam, triazolam) (used for severe insomnia and stress)

• Omeprazole (used for treating ulcers) • Oral contraceptives (if you take

  Voriconazole whilst using oral contraceptives, you may get side effects such as nausea and menstrual disorders)

• Vinca alkaloids (e.g., vincristine and vinblastine) (used in treating cancer) • Tyrosine kinase inhibitors (e.g., axitinib, bosutinib, cabozantinib, ceritinib, cobimetinib, dabrafenib, dasatinib, nilotinib, sunitinib, ibrutinib, ribociclib) (used for treating cancer)
• Tretinoin (used to treat leukaemia) • Indinavir and other HIV protease inhibitors (used for treating HIV) • Non-nucleoside reverse transcriptase inhibitors (e.g., efavirenz, delavirdine, nevirapine) (used for treating HIV) (some doses of efavirenz can NOT be taken at the same time as Voriconazole) • Methadone (used to treat heroin addiction)
• Alfentanil and fentanyl and other short-acting opiates such as sufentanil (painkillers used for surgical procedures)
• Oxycodone and other long-acting opiates such as hydrocodone (used for moderate to severe pain)

• Non-steroidal anti-inflammatory drugs

  (e.g., ibuprofen, diclofenac) (used for treating pain and inflammation) • Fluconazole (used for fungal infections) • Everolimus (used for treating advanced kidney cancer and in transplant patients) • Letermovir (used for preventing cytomegalovirus (CMV) disease after bone marrow transplant)

• Mavacamten (used to treat adults with a type of heart disease called obstructive hypertrophic cardiomyopathy) • Ivacaftor (used to treat cystic fibrosis) • Flucloxacillin (antibiotic used against bacterial infections)

Pregnancy and breast-feeding

Voriconazole must not be taken during pregnancy, unless indicated by your doctor. Effective contraception must be used in women of childbearing potential. Contact your doctor immediately if you become pregnant while taking Voriconazole. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machines

Voriconazole may cause blurring of vision or uncomfortable sensitivity to light. While affected, do not drive or operate any tools or machines. Contact your doctor if you experience this.

Voriconazole contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine. Voriconazole contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

3. How to take Voriconazole

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Your doctor will determine your dose depending on your weight and the type of infection you have.

The recommended dose for adults (including elderly patients) is as follows:

Tablets

Patients

40 kg and above

Patients less than 40 kg

Dose for the first

24 hours (Loading

Dose)

400 mg every 12 hours for the first

24 hours

200 mg every 12 hours for the first 24 hours Dose after the

first 24 hours

Maintenance Dose)

200 mg twice a day

100 mg twice a day

Depending on your response to treatment, your doctor may increase the daily dose to 300 mg twice a day.

The doctor may decide to decrease the dose if you have mild to moderate cirrhosis. Use in children and adolescents

The recommended dose for children and teenagers is as follows:

Tablets

Children aged

2 to less than

12 years and

teenagers

aged 12 to 14

years weighing

less than 50 kg

Teenagers aged 12 to 14 years weighing 50 kg or more; and all teenagers older than 14 Dose for

the first

24hours

(Loading

Dose)

Your treatment

will be started

as an infusion

400 mg every 12 hours for the first 24 hours

Dose after the first

24hours

(Main-

tenance

Dose)

9 mg/kg twice

a day (a

maximum dose

of

350 mg twice

daily)

200 mg twice a day Package Leaflet: Information for the user

Voriconazole 50 mg film-coated tablets Voriconazole 200 mg film-coated tablets

voriconazole

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Depending on your response to treatment, your doctor may increase or decrease the daily dose.

• Tablets must only be given if the child is

  able to swallow tablets.

Take your tablet at least one hour before, or one hour after a meal. Swallow the tablet whole with some water.

If you or your child are taking Voriconazole for prevention of fungal infections, your doctor may stop giving Voriconazole if you or your child develop treatment related side effects.

If you take more Voriconazole than you should

If you take more tablets than prescribed (or if someone else takes your tablets) you must seek medical advice or go to the nearest hospital casualty department immediately. Take your box of Voriconazole tablets with you. You may experience abnormal intolerance to light as a result of taking more Voriconazole than you should. If you forget to take Voriconazole

It is important to take your Voriconazole tablets regularly at the same time each day. If you forget to take one dose, take your next dose when it is due. Do not take a double dose to make up for a forgotten dose.

If you stop taking Voriconazole

It has been shown that taking all doses at the appropriate times may greatly increase the effectiveness of your medicine. Therefore unless your doctor instructs you to stop treatment, it is important to keep taking Voriconazole correctly, as described above.

Continue taking Voriconazole until your doctor tells you to stop. Do not stop treatment early because your infection may not be cured. Patients with a weakened immune system or those with difficult infections may require long-term treatment to prevent the infection from returning. When Voriconazole treatment is stopped by your doctor you should not experience any effects.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If any side effects occur, most are likely to be minor and temporary. However, some may be serious and need medical attention. Serious side effects – Stop taking Voriconazole and see a doctor immediately

• Rash

• Jaundice; Changes in blood tests of liver

  function

• Pancreatitis

Other side effects

Very common: may affect more than 1 in 10 people

• Visual impairment (change in vision

  including blurred vision, visual colour alterations, abnormal intolerance to visual perception of light, colour blindness, eye disorder, halo vision, night blindness,swinging vision, seeing sparks, visual aura, visual acuity reduced, visual brightness, loss of part of the usual field of vision, spots before the eyes)

• Fever
• Rash
• Nausea, vomiting, diarrhoea
• Headache
• Swelling of the extremities
• Stomach pains

• Breathing difficulties

  • Elevated liver enzymes Common: may affect up to 1 in 10 people

  • Inflammation of the sinuses,

    inflammation of the gums, chills, weakness

  • Low numbers of some types,

    including severe, of red (sometimes immune-related) and/ or white blood cells (sometimes with fever), low numbers of cells called platelets that help the blood to clot

• Low blood sugar, low blood potassium,

  low sodium in the blood

• Anxiety, depression, confusion, agitation,

  inability to sleep, hallucinations

• Seizures, tremors or uncontrolled

  muscle movements, tingling or abnormal skin sensations, increase in muscle tone, sleepiness, dizziness

• Bleeding in the eye

• Heart rhythm problems including very

  fast heartbeat, very slow heartbeat, fainting

• Low blood pressure, inflammation of a

  vein (which may be associated with the formation of a blood clot)

• Acute breathing difficulty, chest pain,

  swelling of the face (mouth, lips and around eyes), fluid accumulation in the lungs

• Constipation, indigestion, inflammation

  of the lips

• Jaundice, inflammation of the liver and

  liver injury

• Skin rashes which may lead to severe

  blistering and peeling of the skin characterized by a flat, red area on the skin that is covered with small confluent bumps, redness of the skin

• Itchiness
• Hair loss
• Back pain

• Kidney failure, blood in the urine,

  changes in kidney function tests

• Sunburn or severe skin reaction

  following exposure to light or sun

• Skin cancer

Uncommon: may affect up to 1 in 100 people

• Flu-like symptoms, irritation and

  inflammation of the gastrointestinal tract, inflammation of the gastrointestinal tract causing antibiotic associated diarrhoea, inflammation of the lymphatic vessels

• Inflammation of the thin tissue that

  lines the inner wall of the abdomen and covers the abdominal organ

• Enlarged lymph glands (sometimes

  painful), failure of blood marrow, increased eosinophil

• Depressed function of the adrenal gland,

  underactive thyroid gland

• Abnormal brain function, Parkinson-

  like symptoms, nerve injury resulting in numbness, pain, tingling or burning in the hands or feet

• Problems with balance or coordination
• Swelling of the brain

• Double vision, serious conditions of the

  eye including: pain and inflammation of the eyes and eyelids, abnormal eye movement, damage to the optic nerve resulting in vision impairment, optic disc swelling

• Decreased sensitivity to touch
• Abnormal sense of taste

• Hearing difficulties, ringing in the ears,

  vertigo

• Inflammation of certain internal organs-

  pancreas and duodenum, swelling and inflammation of the tongue

• Enlarged liver, liver failure, gallbladder

  disease, gallstones

• Joint inflammation, inflammation of the

  veins under the skin (which may be associated with the formation of a blood clot)

  • Inflammation of the kidney, proteins in the urine, damage to the kidney

  • Very fast heart rate or skipped

    heartbeats, sometimes with erratic electrical impulses

  • Abnormal electrocardiogram (ECG)
  • Blood cholesterol increased, blood urea increased
  • Allergic skin reactions (sometimes severe), including life-threatening skin condition that causes painful blisters and sores of the skin and mucous membranes, especially in the mouth, inflammation of the skin, hives, skin redness and irritation, red or purple discoloration of the skin which may be caused by low platelet count, eczema
  • Infusion site reaction
  • Allergic reaction or exaggerated immune response
  • Inflammation of the tissue surrounding the bone

Rare:may affect up to 1 in 1000 people

• Overactive thyroid gland
• Deterioration of brain function that is a serious complication of liver disease
• Loss of most fibres in the optic nerve, clouding of the cornea, involuntary movement of the eye
• Bullous photosensitivity
• A disorder in which the body’s immune system attacks part of the peripheral nervous system

• Heart rhythm or conduction problems

  (sometimes life threatening)

• Life threatening allergic reaction
• Disorder of blood clotting system
• Allergic skin reactions (sometimes severe), including rapid swelling (oedema) of the dermis, subcutaneous tissue, mucosa and submucosal tissues, itchy or sore patches of thick, red skin with silvery scales of skin, irritation of the skin and mucous membranes, life-threatening skin condition that causes large portions of the epidermis, the skin's outermost layer, to detach from the layers of skin below
• Small dry scaly skin patches, sometimes thick with spikes or ‘horns’

Side effects with frequency not known:

• Freckles and pigmented spots Other significant side effects whose frequency is not known, but should be reported to your doctor immediately:
• Red, scaly patches or ring-shaped skin lesions that may be a symptom of an autoimmune disease called cutaneous lupus erythematosus

As Voriconazole has been known to affect the liver and the kidney, your doctor should monitor the function of your liver and kidney by doing blood tests. Please advise your doctor if you have any stomach pains or if your stools have a different consistency. There have been reports of skin cancer in patients treated with Voriconazole for long periods of time.

Sunburn or severe skin reaction following exposure to light or sun was experienced more frequently in children. If you or your child develops skin disorders, your doctor may refer you to a dermatologist, who after consultation may decide that it is important for you or your child to be seen on a regular basis.

Elevated liver enzymes were also observed more frequently in children.

If any of these side effects persist or are troublesome, please tell your doctor. Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Voriconazole

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label, bottle and carton, after EXP. The expiry date refers to the last day of that month.

This medicine does not require any special storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Voriconazole contains

• The active substance is voriconazole. Each film-coated tablet contains 50 mg voriconazole.

  Each film-coated tablet contains 200 mg voriconazole.

• The other ingredients are

  Tablet Core: Lactose monohydrate, pregelatinized, starch (Maize starch), maize starch, croscarmellose sodium, povidone (K - 30) , silica, colloidal Anhydrous, magnesium stearate. Tablet coating: Hypromellose 2910, lactose monohydrate, titanium dioxide (E 171), triacetin.

What Voriconazole looks like and contents of the pack

Film coated tablet.

Voriconazole 50 mg film-coated tablets White, round, biconvex, film coated tablets debossed with ‘CC’ on one side and ‘52’ on the other side.

Voriconazole 200 mg film-coated tablets White, oval shaped, biconvex, film coated tablets debossed with ‘CC’ and ‘56’ separated by a break line on one side and plain on the other side.

The tablet can be divided into equal doses. Voriconazole film-coated tablets are available in Clear PVC - Aluminium foil blister pack and HDPE container packs. Pack sizes:

Blister packs: 10, 14, 28, 30, 50, 56, 90 and 100 film-coated tablets.

HDPE packs: 100 and 250 film-coated tablets.

Not all pack sizes may be marketed. Marketing Authorisation Holder

Milpharm Limited

1 Roundwood Avenue,

Stockley Park,

Uxbridge,

UB11 1AF

United Kingdom

Manufacturer

APL Swift Services (Malta) Limited HF26, Hal Far Industrial Estate, Hal Far Birzebbugia, BBG 3000

Malta

or

Milpharm Limited

1 Roundwood Avenue,

Stockley Park,

Uxbridge,

UB11 1AF

United Kingdom

This leaflet was last revised in 09/2026.

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