Voriconazole sandoz

Package leaflet: Information for the patient

Voriconazole Sandoz, 200 mg, powder for solution for infusion
Voriconazolum
Please read this leaflet carefully before using this medicine because it contains important information for you.

• Keep this leaflet so that you can read it again if necessary.
• If you have any questions, please consult your doctor, pharmacist, or nurse.
• This medicine has been prescribed for a specific individual. Do not pass it on to others. This medicine may harm someone else, even if their symptoms are the same.
• If you experience any adverse effects, including any not listed in this leaflet, inform your doctor, pharmacist, or nurse. See section 4.

Leaflet contents:

1. What Voriconazole Sandoz is and what it is used for
2. Important information before using Voriconazole Sandoz
3. How to use Voriconazole Sandoz
4. Possible side effects
5. How to store Voriconazole Sandoz
6. Contents of the pack and other information

1. What Voriconazole Sandoz is and what it is used for

Voriconazole Sandoz contains the active substance voriconazole. Voriconazole Sandoz is an antifungal medicine that kills or inhibits the growth of fungi causing infections.
This medicine is used to treat patients (adults and children over 2 years of age) with:
invasive aspergillosis (a type of fungal infection caused by fungi of the genus Aspergillus);
candidaemia (another type of fungal infection caused by fungi of the genus Candida) in patients without neutropenia (patients who do not have abnormally low white blood cell counts);
serious invasive fungal infections caused by Candida species resistant to fluconazole (another antifungal medicine);
serious fungal infections caused by fungi of the genus Scedosporium or Fusarium (two different types of fungi).
Voriconazole Sandoz is intended for patients with progressive, potentially life-threatening fungal infections.
The medicine is also indicated for the prevention of fungal infections in high-risk patients after bone marrow transplantation.
This medicine should only be used under the supervision of a doctor.

2. Important information before using Voriconazole Sandoz

When not to use Voriconazole Sandoz:

• if the patient is allergic to voriconazole or to sulfobutylether beta-cyclodextrin sodium (listed in section 6).

It is very important to inform your doctor or pharmacist about all medicines currently or recently taken by the patient, as well as any medicines the patient plans to use, including those available without a prescription or herbal medicines.
The following medicines must not be used during treatment with Voriconazole Sandoz:
terfenadine (used to treat allergies);
astemizole (used to treat allergies);
cisapride (used for stomach disorders);
pimozide (used to treat psychiatric disorders);
quinidine (used for heart rhythm disorders);
ivabradine (used to treat symptoms of chronic heart failure);
rifampicin (used to treat tuberculosis);
efavirenz (used to treat HIV infection) at doses of 400 mg or higher taken once daily;
carbamazepine (used to treat epilepsy);
phenobarbital (used to treat severe insomnia and epilepsy);
ergot alkaloids (e.g. ergotamine, dihydroergotamine, used to treat migraine);
sirolimus (used in organ transplant patients);
ritonavir (used to treat HIV infection) at doses of 400 mg or higher taken twice daily;
St. John’s wort (herbal remedy);
naloxegol [used to treat constipation caused by opioid pain medicines (e.g. morphine, oxycodone, fentanyl, tramadol, codeine)];
tolvaptan [used to treat hyponatremia (low sodium levels in blood) or to slow the decline of kidney function 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 diseases);
voclosporin (used to treat immune disorders);
venetoclax [used to treat patients with chronic lymphocytic leukaemia (CLL)].

Warnings and precautions
Before using Voriconazole Sandoz, discuss with your doctor, pharmacist, or nurse if:
 the patient has previously had an allergic reaction to other azoles;
 the patient has or has ever had liver disease. The doctor may prescribe a lower dose of Voriconazole Sandoz and recommend blood tests to monitor liver function during treatment.
 the patient has been diagnosed with cardiomyopathy, irregular heartbeat, slow heart rate, or has had an electrocardiogram (ECG) finding called "prolonged QT interval".

During treatment, avoid any exposure to sunlight. It is important to wear protective clothing and use sunscreen with a high sun protection factor (SPF), as skin photosensitivity reactions (UV sensitivity) may occur. This may be further increased by other medicines that make the skin more sensitive to sunlight, such as methotrexate. These precautions also apply to children.

While taking Voriconazole Sandoz:
inform the doctor immediately if the patient experiences:
o sunburn
o severe rash or blisters on the skin
o bone pain

The patient experiencing the skin changes described above may be referred by the doctor to a dermatologist. Regular dermatological consultations may be necessary. Long-term use of Voriconazole Sandoz may be associated with a small risk of developing skin cancer.

Tell the doctor if the patient develops symptoms of "adrenal insufficiency", a condition in which the adrenal glands do not produce enough steroid hormones such as cortisol. Symptoms include: chronic or prolonged fatigue, muscle weakness, loss of appetite, weight loss, abdominal pain.

If the patient develops symptoms of "Cushing's syndrome", in which the body produces too much of the hormone cortisol, leading to symptoms such as: weight gain, development of a fatty hump between the shoulders, rounded face, darkening of the skin on the abdomen, thighs, chest, and arms, thinning of the skin, increased tendency to bruising, elevated blood sugar levels, excessive hair growth, and excessive sweating, inform the doctor.

The doctor will monitor the patient’s liver and kidney function through blood tests.

Children and adolescents
Voriconazole Sandoz must not be used in children under 2 years of age.

Voriconazole Sandoz and other medicines
Tell your doctor or pharmacist about all medicines currently or recently taken by the patient, as well as any medicines the patient plans to use, including those available without a prescription.

Some medicines taken together with Voriconazole Sandoz may alter its effect, and Voriconazole Sandoz may also affect the action of other medicines.

If the patient is taking any of the following medicines, inform the doctor, as their concomitant use with Voriconazole Sandoz should be avoided whenever possible:
 ritonavir (used to treat HIV infection) at a dose of 100 mg taken twice daily
 glasdegib (used to treat cancers) — if co-administration is necessary, the doctor will order frequent monitoring of heart rhythm.

If the patient is taking any of the following medicines, inform the doctor, as their concomitant use with Voriconazole Sandoz should be avoided whenever possible, or dose adjustment of voriconazole may be required:
rifabutin (used to treat tuberculosis). If the patient is being treated with rifabutin, monitoring of blood counts and observation for adverse effects of rifabutin will be necessary.
phenytoin (used to treat epilepsy). If the patient is being treated with phenytoin, monitoring of its blood levels will be required during Voriconazole Sandoz treatment, and the doctor may adjust the dose.

If the patient is taking any of the following medicines, inform the doctor, as dose adjustment or monitoring may be necessary to ensure that these medicines and/or Voriconazole Sandoz continue to have the expected effect:
warfarin and other anticoagulants (e.g. phenprocoumon, acenocoumarol; used to reduce blood clotting);
cyclosporine (used after organ transplantation);
tacrolimus (used after organ transplantation);
sulfonylureas, e.g. tolbutamide, glipizide, and glyburide (used to treat diabetes);
statins, e.g. atorvastatin, simvastatin (used to reduce cholesterol levels);
benzodiazepines, e.g. midazolam, triazolam (used for severe insomnia and stress);
omeprazole (used to treat peptic ulcer disease);
oral contraceptives (if Voriconazole Sandoz is used together with oral contraceptives, adverse effects such as nausea and menstrual irregularities may occur);
vinca alkaloids, e.g. vincristine and vinblastine (used to treat cancers);
tyrosine kinase inhibitors, e.g. axitinib, bosutinib, cabozantinib, ceritinib, cobimetinib, dabrafenib, dasatinib, nilotinib, sunitinib, ibrutinib, ribociclib (used to treat cancers);
tretinoin (used to treat leukaemia);
indinavir and other HIV protease inhibitors (used to treat HIV infection);
non-nucleoside reverse transcriptase inhibitors, e.g. efavirenz, delavirdine, nevirapine (used to treat HIV infection); certain doses of efavirenz must NOT be used together with Voriconazole Sandoz;
methadone (used to treat heroin addiction);
alfentanil, fentanyl, and other short-acting opioid pain medicines such as sufentanil (used as pain relief during surgical procedures);
oxycodone and other long-acting opioid pain medicines such as hydrocodone (used to treat moderate or severe pain);
non-steroidal anti-inflammatory drugs, e.g. ibuprofen, diclofenac (used to treat pain and inflammation);
fluconazole (used to treat fungal infections);
everolimus (used to treat advanced kidney cancer and in organ transplant patients);
letermovir [used to prevent cytomegalovirus (CMV) disease after bone marrow transplantation];
ivacaftor (used to treat cystic fibrosis);
flucloxacillin (an antibiotic used to treat bacterial infections).

Pregnancy and breastfeeding
Voriconazole Sandoz must not be used during pregnancy unless otherwise decided by the doctor.
Women of childbearing potential must use effective contraception during treatment with Voriconazole Sandoz. If the patient becomes pregnant while taking Voriconazole Sandoz, she should contact her doctor immediately.
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning to have a baby, she should consult her doctor or pharmacist before using this medicine.

Driving and using machines
Voriconazole Sandoz may cause visual disturbances and discomfort due to light sensitivity. In such cases, driving and operating machinery should be avoided.
If such disturbances occur, contact your doctor.

Voriconazole Sandoz contains sodium and sulfobutylether beta-cyclodextrin sodium
This medicine contains up to 228.7 mg of sodium (the main component of table salt) per vial. This corresponds to 11.4% of the maximum recommended daily dietary sodium intake for adults.
This medicine contains 3.4 g of sulfobutylether beta-cyclodextrin sodium per vial. If the patient has kidney disease, they should contact their doctor before using this medicine.

3. How to use Voriconazole Sandoz

This medicine should always be used exactly as prescribed by your doctor. In case of doubt, consult your doctor.

The dose is determined by the doctor based on the patient's body weight and type of infection. The doctor may also adjust the dose depending on the patient's health condition.

Below are the recommended dosages for adults (including elderly patients).

Intravenous administration

Dosing during the first 24 hours
6 mg/kg body weight every 12 hours
(loading dose)

Dosing after the first 24 hours
4 mg/kg body weight twice daily
(maintenance dose)

Depending on the patient's response to treatment, the doctor may reduce the dose to 3 mg/kg body weight twice daily.

If the patient has mild or moderate liver cirrhosis, the doctor may decide to reduce the dose.

Use in children and adolescents

The recommended dosages for children and adolescents are presented below.

Intravenous administration

Children aged 2 to <12 years and adolescents aged 12 to 14 years with body weight <50 kg
Adolescents aged 12 to 14 years with body weight ≥50 kg and adolescents over 14 years

Dosing during the first 24 hours
9 mg/kg body weight every 12 hours
(loading dose)
6 mg/kg body weight every 12 hours
(loading dose)

Dosing after the first 24 hours
8 mg/kg body weight twice daily
(maintenance dose)
4 mg/kg body weight twice daily
(maintenance dose)

Depending on the patient's response to treatment, the doctor may increase or decrease the daily dose.

Voriconazole Sandoz as a powder for solution for infusion will be dissolved and the resulting solution diluted to the appropriate concentration by hospital staff prior to administration (further information is provided at the end of this leaflet).

The medicine is administered intravenously over 1 to 3 hours at a maximum infusion rate of 3 mg/kg body weight/hour.

If adverse reactions related to treatment occur in a patient receiving Voriconazole Sandoz for prevention of fungal infections, the treating physician may discontinue administration of Voriconazole Sandoz.

Missed dose of Voriconazole Sandoz

This medicine is administered under strict medical supervision, so missing a dose is unlikely. However, if the patient has any doubts whether the medicine was administered, consult the doctor or pharmacist.

Discontinuation of Voriconazole Sandoz

The duration of treatment is determined by the doctor, but intravenous Voriconazole Sandoz should not be used for longer than 6 months.

Long-term treatment may be necessary in patients with weakened immunity or severe infections to prevent disease recurrence. After clinical improvement, the doctor may switch intravenous treatment to oral therapy (tablets).

If discontinuation of Voriconazole Sandoz is decided by the doctor, there is no need to worry about consequences of stopping treatment.

In case of any further doubts regarding the use of this medicine, consult your doctor, pharmacist, or nurse.

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everyone will experience them.
If an adverse reaction occurs, it is most commonly mild and transient. However, some of them
can be serious and may require medical attention.
Serious adverse reactions − discontinue Voriconazole Sandoz treatment immediately and
consult a doctor:
rash
jaundice; changes in blood test results assessing liver function
pancreatitis

Other adverse reactions
Very common (may affect more than 1 in 10 people):
visual disturbances (changes in vision, including blurred vision, changes in color vision,
abnormal light sensitivity, loss of color vision, eye disorders, seeing halos, night blindness,
feeling of flickering images, seeing sparks, visual aura, reduced visual acuity, bright vision,
loss of part of the normal visual field, floaters)
fever
rash
nausea, vomiting, diarrhoea
headache
swelling of limbs
abdominal pain
difficulty breathing
increased liver enzyme activity

Common (may affect less than 1 in 10 people):
sinusitis, gingivitis, chills, weakness
low (sometimes significantly low) number of certain types of red blood cells (sometimes immune-related) and (or) white blood cells (sometimes with fever), low number of cells called platelets that help blood clot
low blood sugar level, low blood potassium level, low blood sodium level
anxiety, depression, confusion, agitation, insomnia, hallucinations
seizures, tremor or uncontrolled muscle movements, tingling or unusual sensations in the skin, increased muscle tension, somnolence, dizziness
bleeding in the eye
heart rhythm disorders, including very rapid heartbeat, very slow heartbeat, fainting
low blood pressure, inflammation of veins (which may be associated with blood clot formation)
acute breathing difficulties, chest pain, facial swelling (oral cavity, lips, and around the eyes), fluid accumulation in the lungs
constipation, indigestion, inflammation of lips
jaundice, hepatitis and liver damage
skin rash which may progress to a severe blistering form and skin peeling, characterized by a flat, red area on the skin covered with small merging bumps, skin redness
itching
hair loss
back pain
kidney failure, presence of blood in urine, changes in blood test results assessing kidney function
sunburn or severe skin reaction after exposure to light or sunlight
skin cancer

Uncommon (may affect less than 1 in 100 people):
influenza-like symptoms, irritation and inflammation of the mucous membrane of the gastrointestinal tract, gastrointestinal inflammation causing antibiotic-associated diarrhoea, inflammation of lymphatic vessels
inflammation of the thin tissue lining the inner wall of the abdominal cavity and covering the organs within it
enlarged lymph nodes (sometimes painful), bone marrow failure, increased number of eosinophils
adrenal gland dysfunction, hypothyroidism
impaired brain function, symptoms resembling Parkinson's disease, nerve damage causing numbness, pain, tingling or burning sensation in hands or feet
balance or coordination disorders
brain swelling
double vision, severe eye disorders including eye pain and inflammation of eyeballs and eyelids, abnormal eye movements, optic nerve damage leading to vision disturbances, optic disc swelling
reduced sensitivity to touch
taste disturbances
hearing disorders, tinnitus, dizziness
inflammation of certain internal organs – pancreas and duodenum, swelling and inflammation of the tongue
liver enlargement, liver failure, gallbladder disorders, gallstones
joint inflammation, inflammation of subcutaneous veins (which may lead to clot formation)
kidney inflammation, presence of protein in urine, kidney damage
very rapid heartbeat or missed heartbeats, sometimes with abnormal electrical impulses
abnormal electrocardiogram (ECG) findings
increased blood cholesterol level, increased blood urea level
allergic skin reactions (sometimes severe), including life-threatening condition characterized by painful blisters with associated skin and mucous membrane pain, particularly in the oral cavity, skin inflammation, urticaria, redness or skin irritation, red or purple skin discolorations which may be caused by low platelet count, rash
injection site reaction
allergic reaction or excessive immune response
inflammation of tissue surrounding the bone

Rare (may affect less than 1 in 1000 people):
hyperthyroidism
worsening of brain function, which is a serious complication of liver disease
loss of most of the optic nerve fibers, corneal opacity, involuntary eye movements
blistering skin rash due to photosensitivity
disorders in which the immune system attacks part of the peripheral nervous system
heart rhythm or conduction disorders (sometimes life-threatening)
life-threatening allergic reaction
blood clotting disorders
allergic skin reactions (sometimes severe), including sudden swelling of the skin, subcutaneous tissue, mucous membranes and submucosal tissues, itchy or painful patches of thickened, red skin with silvery scales, skin and mucous membrane irritation, life-threatening skin disease involving detachment of large sheets of the epidermis (outer skin layer) from deeper skin layers
appearance of small, dry, scaly skin patches, sometimes thickened, with sharp projections or "horns"

Frequency not known (cannot be estimated from available data):
freckles and pigmented spots

Other important adverse reactions, the frequency of which is unknown, but which should be reported to a doctor immediately:
red, peeling skin patches or ring-shaped skin changes, which may be symptoms of an autoimmune disease called cutaneous lupus erythematosus

Reactions during Voriconazole Sandoz infusion (hot flushes, fever, excessive sweating, rapid heartbeat, and shortness of breath) occur uncommonly. The doctor may then interrupt the administration of the medicine.

Due to the known effects of Voriconazole Sandoz on the liver and kidneys, your doctor will monitor the function of these organs by ordering appropriate blood tests. If abdominal pain or changes in stool consistency occur, consult your doctor.

There have been reports of skin cancer development in patients receiving long-term voriconazole treatment.
Sunburn or severe skin reactions after exposure to light or sunlight occurred more frequently in children. If skin disorders occur, the doctor may refer the patient to a dermatologist, who after consultation may decide on the need for regular follow-up visits. Increased liver enzyme activity has also been observed more frequently in children.

If any of these adverse reactions persist or become bothersome, inform your doctor.

Reporting of adverse reactions
If any adverse symptoms occur, including any adverse reactions not listed in this leaflet, inform your doctor, pharmacist, or nurse. Adverse reactions can be reported directly to the Department of Monitoring Adverse Drug Reactions of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products: Al. Jerozolimskie 181C, 02-222 Warsaw
tel.: +48 22 49 21 301, fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl
Adverse reactions can also be reported to the marketing authorization holder.
Reporting adverse reactions helps provide more information on the safety of this medicine.

5. How to store Voriconazole Sandoz

Keep the medicine out of the sight and reach of children.
Do not use this medicine after the expiry date stated on the label and the outer carton after "EXP". The expiry date refers to the last day of the stated month.
Store below 30°C.

Reconstituted solution
The reconstituted solution has been shown to be chemically and physically stable for 24 hours at a temperature of 2°C to 8°C.

Infusion solution after dilution
The diluted solution has been shown to be chemically and physically stable for 3 hours at a temperature of 20°C to 30°C.

From a microbiological standpoint, the prepared solution should be used immediately. Otherwise, the responsibility for storage conditions and duration prior to use lies with the user. Under normal circumstances, the storage time should not exceed 24 hours at 2°C to 8°C (refrigerator), unless the solution was prepared under controlled and validated aseptic conditions.
(Further information is provided at the end of the leaflet.)

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. Such measures will help protect the environment.

6. Contents of the pack and other information

What Voriconazole Sandoz contains

• The active substance is voriconazole. Each vial contains 200 mg of powder for solution for infusion, corresponding to a concentration of 10 mg/ml after reconstitution according to instructions provided by a hospital pharmacist or nurse (see information at the end of the leaflet).
• The other ingredient is: sodium sulfobutylether β-cyclodextrin

What Voriconazole Sandoz looks like and contents of the pack
Clear, single-use 25 ml vials made of type I glass,
closed with a rubber stopper and flip-off seal with a plastic disc,
packaged in a cardboard box.
Pack sizes: 1 or 10 vials of powder for solution for infusion.

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Sandoz GmbH
Biochemiestrasse 10
6250 Kundl, Austria

Manufacturers
Lek Pharmaceuticals d.d.
Verovškova 57
1526 Ljubljana, Slovenia
Salutas Pharma GmbH
Otto-von-Guericke-Allee 1
39179 Barleben, Germany

For further information about the medicinal product and its names in other European Economic Area member states, please contact:
Sandoz Polska Sp. z o.o.
ul. Domaniewska 50 C
02-672 Warszawa
tel. 22 209 70 00

Information intended exclusively for healthcare professionals:
Reconstitution and dilution of the solution
 Voriconazole Sandoz powder for solution for infusion must be dissolved in 19 ml of water for injections or 19 ml of 0.9% (9 mg/ml) sodium chloride solution for infusion to obtain 20 ml of a clear concentrate containing voriconazole at a concentration of 10 mg/ml.
 If the vacuum in the vial does not allow the diluent to enter, such a vial should be discarded.
 To measure the exact volume (19.0 ml) of water for injections or 0.9% sodium chloride solution for infusion, use of a standard (non-automatic) 20 ml syringe is recommended.
 To obtain the final Voriconazole Sandoz solution containing voriconazole at a concentration of 0.5–5 mg/ml, the required volume of concentrate should be added to one of the following recommended compatible infusion solutions.
 The medicinal product is intended for single use only, and any unused portions of the solution must be discarded. Only clear solutions free from particulate matter should be used.
 The medicine is not intended for rapid intravenous bolus administration.
 For storage information, see section 5 "How to store Voriconazole Sandoz".

Required volumes of Voriconazole Sandoz concentrate 10 mg/ml
Body weight Volume of Voriconazole Sandoz concentrate (10 mg/ml) required to prepare:
(kg) 3 mg/kg 4 mg/kg 6 mg/kg 8 mg/kg 9 mg/kg
(number of vials) (number of vials) (number of vials) (number of vials) (number of vials)
10 - 4.0 ml (1) - 8.0 ml (1) 9.0 ml (1)
15 - 6.0 ml (1) - 12.0 ml (1) 13.5 ml (1)
20 - 8.0 ml (1) - 16.0 ml (1) 18.0 ml (1)
25 - 10.0 ml (1) - 20.0 ml (1) 22.5 ml (1)
30 9.0 ml (1) 12.0 ml (1) 18.0 ml (1) 24.0 ml (2) 27.0 ml (2)
35 10.5 ml (1) 14.0 ml (1) 21.0 ml (2) 28.0 ml (2) 31.5 ml (2)
40 12.0 ml (1) 16.0 ml (1) 24.0 ml (2) 32.0 ml (2) 36.0 ml (2)
45 13.5 ml (1) 18.0 ml (1) 27.0 ml (2) 36.0 ml (2) 40.5 ml (3)
50 15.0 ml (1) 20.0 ml (1) 30.0 ml (2) 40.0 ml (2) 45.0 ml (3)
55 16.5 ml (1) 22.0 ml (2) 33.0 ml (2) 44.0 ml (3) 49.5 ml (3)
60 18.0 ml (1) 24.0 ml (2) 36.0 ml (2) 48.0 ml (3) 54.0 ml (3)
65 19.5 ml (1) 26.0 ml (2) 39.0 ml (2) 52.0 ml (3) 58.5 ml (3)
70 21.0 ml (2) 28.0 ml (2) 42.0 ml (3) - -
75 22.5 ml (2) 30.0 ml (2) 45.0 ml (3) - -
80 24.0 ml (2) 32.0 ml (2) 48.0 ml (3) - -
85 25.5 ml (2) 34.0 ml (2) 51.0 ml (3) - -
90 27.0 ml (2) 36.0 ml (2) 54.0 ml (3) - -
95 28.5 ml (2) 38.0 ml (2) 57.0 ml (3) - -
100 30.0 ml (2) 40.0 ml (2) 60.0 ml (3) - -

Voriconazole Sandoz is a preservative-free, sterile lyophilisate intended for single-dose administration. Therefore, from a microbiological point of view, the reconstituted solution should be used immediately. Otherwise, the responsibility for the storage time and conditions prior to use lies with the user. The storage time should not exceed 24 hours at a temperature of 2°C to 8°C, unless the solution was prepared under controlled and validated aseptic conditions.

Compatible infusion solutions
The reconstituted solution may be diluted using:

• 0.9% (9 mg/ml) sodium chloride solution for infusion
• Ringer's lactate solution for infusion
• 5% glucose and Ringer's lactate solution for infusion
• 5% glucose and 0.45% sodium chloride solution for infusion
• 5% glucose solution for infusion
• 5% glucose in 20 mEq potassium chloride solution for infusion
• 0.45% sodium chloride solution for infusion
• 5% glucose and 0.9% sodium chloride solution for infusion

Compatibility of voriconazole with diluents other than those listed above (or below under "Incompatibilities") is unknown.

Incompatibilities
Voriconazole Sandoz solution must not be administered simultaneously with other medicinal products in the same infusion line or intravenous access. This also applies to parenteral nutrition.
Blood products must not be administered concurrently with Voriconazole Sandoz.
Parenteral nutrition in infusion may be administered simultaneously with Voriconazole Sandoz, but must be given through a separate intravenous access or infusion line.
4.2% sodium bicarbonate solution for infusion must not be used to dilute Voriconazole Sandoz.