Voriconazole Accord
voriconazole
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor, pharmacist or nurse.
This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.
What Voriconazole Accord is and what it is used for
What you need to know before you take Voriconazole Accord
How to take Voriconazole Accord
Possible side effects
How to store Voriconazole Accord
Content of the pack and other information
Voriconazole Accord contains the active substance voriconazole. Voriconazole Accord 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 Accord 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.
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 Accord 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)
Venetoclax (used to treat patients with chronic lymphocytic leukaemia-CLL)
Talk to your doctor, pharmacist or nurse before taking Voriconazole Accord 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 Accord. Your doctor should also monitor your liver function while you are being treated with Voriconazole Accord 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. These precautions are also applicable to children.
While being treated with Voriconazole Accord:
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 Accord.
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.
Voriconazole Accord should not be given to children younger than 2 years of age.
Please 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 Accord, may affect the way Voriconazole Accord works or Voriconazole Accord may affect the way they work.
Tell your doctor if you are taking the following medicine, as treatment with Voriconazole Accord 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 Accord 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 Accord 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 Accord 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 Accord 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 Accord )
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)
Ivacaftor: used to treat cystic fibrosis
Voriconazole Accord 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 Accord.
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.
Voriconazole Accord 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.
If you have been told by your doctor that you have an intolerance to some sugars, tell your doctor before taking Voriconazole Accord.
This medicine contains less than 1 mmol sodium (23 mg) per 50 mg tablet, that is to say essentially
‘sodium free’.
This medicine contains less than 1 mmol sodium (23 mg) per 200 mg tablet, that is to say essentially ‘sodium-free’.
Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.
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
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:
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.
The recommended dose for children and teenagers is as follows:
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 24 hours (Loading Dose) | Your treatment will be started as an infusion | 400 mg every 12 hours for the first 24 hours |
Dose after the first 24 hours (Maintenance Dose) | 9 mg/kg twice a day (a maximum dose of 350 mg twice daily) | 200 mg twice a day |
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 Accord for prevention of fungal infections, your doctor may stop giving Voriconazole Accord if you or your child develop treatment related side effects.
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 Accord tablets with you. You may experience abnormal intolerance to light as a result of taking more Voriconazole Accord than you should.
It is important to take your Voriconazole Accord 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.
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 Accord correctly, as described above.
Continue taking Voriconazole Accord 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 Accord 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.
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.
Rash
Jaundice; Changes in blood tests of liver function
Pancreatitis
Very common: may affect more than 1 in 10 people
Visual impairment (change in vision including blurred vision, visual color 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 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, sunburn or severe skin reaction following exposure to light or sun, 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
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 fibers 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:
Other significant side effects whose frequency is not known, but should be reported to your doctor immediately:
Skin cancer
Inflammation of the tissue surrounding the bone
Red, scaly patches or ring-shaped skin lesions that may be a symptom of an autoimmune disease called cutaneous lupus erythematosus
As Voriconazole Accord 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 Accord 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.
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 national reporting system
listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.
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. 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.
The active substance is voriconazole. Each tablet contains either 50 mg voriconazole (for Voriconazole Accord 50 mg film-coated tablets) or 200 mg voriconazole (for VoriconazoleAccord 200 mg film-coated tablets).
The other ingredients are lactose monohydrate, pregelatinised starch, croscarmellose sodium, povidone and magnesium stearate which make up the tablet core and hypromellose, titanium dioxide (E171), lactose monohydrate and triacetin which make up the film-coat (see section 2, Voriconazole Accord 50 mg film-coated tablets or Voriconazole Accord 200 mg film-coated tablets contain lactose and sodium).
Voriconazole Accord 50 mg film-coated tablets are supplied as white to off white, round, approximate 7.0mm in diameter, film-coated tablets, debossed with ‘V50’ on one side and plain on the other side.
Voriconazole Accord 200 mg film-coated tablets are supplied as white to off white, oval, approximately 15.6 mm in length and 7.8 mm in width, film-coated tablets, debossed with ‘V200’ on one side and plain on the other side.
Voriconazole Accord 50 mg film-coated tablets and 200mg film-coated tablets are available as packs of 2, 10, 14, 20, 28, 30, 50, 56 and 100 or unit dose blister packs (PVC / Aluminium) containing 10x1, 14x1, 28x1, 30x1, 56x1 or 100x1 film-coated tablets.
Not all pack sizes may be marketed.
Accord Healthcare S.L.U.
World Trade Center, Moll de Barcelona, s/n,
Edifici Est 6ª planta, 08039 Barcelona, Spain
Pharmadox Healthcare Ltd. KW20A Kordin Industrial Park, Paola, PLA 3000
Malta
Accord Healthcare Polska Sp.z o.o.,
ul. Lutomierska 50,95-200 Pabianice, Poland
Accord Healthcare B.V., Winthontlaan 200,
3526 KV Utrecht,
The Netherlands
