Indications: invasive aspergillosis; serious infections caused by Scedosporium spp. Fusarium spp. or invasive fluconazole-resistant Candida spp. (including C. krusei) Cautions: electrolyte disturbances, cardiomyopathy, bradycardia, symptomatic arrhythmias, history of QT interval prolongation, concomitant use with other drugs that prolong QT interval; patients at risk of pancreatitis; monitor renal function.

Hepatotoxicity Phototoxicity Contra-indications: acute porphyria

Hepatic impairment: in mild to moderate hepatic cirrhosis use usual loading dose then halve maintenance dose; no information available for severe hepatic cirrhosis—manufacturer advises use only if potential benefit outweighs risk.

Renal impairment: intravenous vehicle may accumulate if eGFR less than 50 ml/minute/1.73 m2—use intravenous infusion only if potential benefit outweighs risk, and monitor renal function; alternatively, use tablets or oral suspension (no dose adjustment required)

Pregnancy: toxicity in animal studies—manufacturer advises avoid unless potential benefit outweighs risk; effective contraception required during treatment.

Breast-feeding: manufacturer advises avoid—no information available.

Side Effects: nausea, vomiting, abdominal pain, diarrhoea, jaundice, oedema, hypotension, chest pain, respiratory distress syndrome, sinusitis, headache, dizziness, asthenia, anxiety, depression, confusion, agitation, hallucinations, paraesthesia, tremor, influenza- like symptoms, hypoglycaemia, haematuria, blood disorders (including anaemia, thrombocytopenia, leucopenia, pancytopenia), acute renal failure, hypokalaemia, visual disturbances (including altered perception, blurred vision, and photophobia), rash, pruritus, photosensitivity, alopecia, cheilitis, injection-site reactions.

less commonly dyspepsia, duodenitis, cholecystitis, pancreatitis, hepatitis, constipation, arrhythmias (including QT interval prolongation), syncope, hyponatraemia, raised serum cholesterol, hypersensitivity reactions (including flushing), ataxia, nystagmus, hypoaesthesia, adrenocortical insufficiency, arthritis, blepharitis, optic neuritis, scleritis, glossitis, gingivitis, psoriasis, Stevens-Johnson syndrome.

rarely pseudomembranous colitis, taste disturbances (more common with oral suspension), convulsions, extrapyramidal effects, insomnia, tinnitus, hearing disturbances, hypertonia, hypothyroidism, hyperthyroidism, discoid lupus erythematosus, toxic epidermal necrolysis, pseudoporphyria, retinal haemorrhage, optic atrophy; also reported on long-term treatment squamous cell carcinoma of skin (particularly in presence of phototoxicity) and periostitis (particularly in transplant patients).

Dose: By mouth, adult over 18 years, body-weight over 40 kg, 400 mg every 12 hours for 2 doses then 200 mg every 12 hours, increased if necessary to 300 mg every 12 hours; body-weight under 40 kg, 200 mg every 12 hours for 2 doses then 100 mg every 12 hours, increased if necessary to 150 mg every 12 hours.

By intravenous infusion: 6 mg/kg every 12 hours for 2 doses, then 4 mg/kg every 12 hours (reduced to 3 mg/kg every 12 hours if not tolerated) for max. 6 months.