Comparative Pharmacology
Head-to-head clinical analysis: MYCELEX versus VORICONAZOLE.
Peer-Reviewed Evidence
Head-to-head clinical analysis: MYCELEX versus VORICONAZOLE.
MYCELEX vs VORICONAZOLE
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Clotrimazole, an imidazole antifungal, inhibits fungal cytochrome P450 14α-demethylase, thereby disrupting ergosterol biosynthesis and compromising fungal cell membrane integrity.
Inhibits fungal CYP450-dependent 14α-lanosterol demethylase, disrupting ergosterol synthesis and increasing membrane permeability.
For oropharyngeal candidiasis: Clotrimazole troche 10 mg dissolved slowly in mouth 5 times daily for 14 days. For vulvovaginal candidiasis: Clotrimazole vaginal tablet 500 mg single dose or 200 mg daily for 3 days or 100 mg daily for 7 days; 1% vaginal cream 5 g intravaginally daily for 7-14 days.
Loading dose: 6 mg/kg IV every 12 hours for 2 doses, then maintenance 4 mg/kg IV every 12 hours; or 200–300 mg PO every 12 hours (400 mg PO every 12 hours for first 24 hours as loading dose if no IV).
None Documented
None Documented
Clinical Note
moderateVoriconazole + Tranilast
"The risk or severity of adverse effects can be increased when Voriconazole is combined with Tranilast."
Clinical Note
moderateVoriconazole + Tolfenamic acid
"The risk or severity of adverse effects can be increased when Voriconazole is combined with Tolfenamic acid."
Clinical Note
moderateVoriconazole + Nimesulide
"The risk or severity of adverse effects can be increased when Voriconazole is combined with Nimesulide."
Clinical Note
moderateTerminal elimination half-life is 20-50 hours (mean ~30 hours) in adults; prolonged in neonates (~40-80 hours) and in hepatic impairment.
The terminal elimination half-life is approximately 6 hours for CYP2C19 extensive metabolizers. In poor metabolizers (which occur in 15-20% of Asian populations), the half-life can be prolonged to up to 24 hours. Clinical context: Dosing adjustments may be necessary based on CYP2C19 genotype; the short half-life necessitates twice-daily dosing for most patients.
Primarily hepatic metabolism; <1% excreted unchanged in urine; ~50% of dose excreted in feces as metabolites.
Voriconazole is primarily metabolized in the liver via CYP2C19, CYP3A4, and to a lesser extent CYP2C9. Less than 2% of the dose is excreted unchanged in urine. Fecal excretion accounts for approximately 20% of the dose, with the remainder as metabolites in urine. Overall, renal elimination of unchanged drug is negligible, but metabolites are excreted renally.
Category C
Category D/X
Azole Antifungal
Azole Antifungal
Voriconazole + Risedronic acid
"The risk or severity of adverse effects can be increased when Voriconazole is combined with Risedronic acid."