Voriconazole (compounded)
Anti-infective · Rx (compounded)
Trade namesCompounded 1%
Drug classAntifungal, triazole (compounded)
Strength1% topical (± oral 200 mg BID)
AvailabilityRx (compounded)
Mechanism of actionInhibits fungal CYP450 14-alpha-demethylase, blocking ergosterol synthesis; broad spectrum with good ocular penetration.
Indication / reason for useFilamentous and yeast keratitis, particularly refractory or deep infection; often combined with natamycin and oral therapy.
Usual adult dosingTopical 1% q1h tapering; oral loading then 200 mg BID under specialist care with LFT monitoring.
PreservativePreservative-free (compounded) , a preservative-free option exists
Contact lensesNo lens wear during fungal keratitis.
Common / important adverse effectsTopical: irritation. Oral: visual disturbances/photopsia, photosensitivity, hepatotoxicity, QT prolongation, many CYP drug interactions.
Contraindications & cautionsCoadministration with CYP3A4 substrates that prolong QT; hepatic impairment.
Pregnancy / lactationAvoid oral voriconazole (teratogenic).
Practice notesThe MUTT trial found natamycin superior to voriconazole for filamentous (esp. Fusarium) keratitis, voriconazole is generally adjunctive.
Chair-side reference only. Dosing, contraindications and pregnancy guidance here are not exhaustive. Confirm against the current prescribing information and the patient’s full history before prescribing or advising.