Posaconazole
From IDWiki
Background
- Azole antifungal
Pharmacokinetics and Pharmacodynamics
- Generally distributes well, with the notable exception of non-inflamed brain
Clinical Breakpoints
| Species | ECV (μg/mL) | Breakpoints (μg/mL) | |||
|---|---|---|---|---|---|
| S | I | SDD | R | ||
| Candida albicans | 0.06 | ≤0.06 | ≥0.12 | ||
| Candida dubliniensis | |||||
| Candida glabrata | 2 | ||||
| Candida guilliermondii | 0.5 | ||||
| Candida kefyr | 0.25 | ||||
| Candida krusei | 0.5 | ||||
| Candida lusitaniae | 0.12 | ||||
| Candida parapsilosis | 0.25 | ≤0.06 | ≥0.12 | ||
| Candida tropicalis | 0.12 | ≤0.06 | ≥0.12 | ||
| Cryptococcus neoformans | |||||
| Cryptococcus gattii | |||||
| Aspergillus flavus | 0.5 | — | — | ||
| Aspergillus fumigatus | 0.25 | ≤0.125 | >0.25 | ||
| Aspergillus nidulans | 0.5 | — | — | ||
| Aspergillus niger | 0.5 | — | — | ||
| Aspergillus terreus | 0.25 | ≤0.125 | >0.25 | ||
Dosing
Therapeutic Drug Monitoring
- Measure trough 7 days after starting or adjusting dose, or adjusting interacting medications, or concerns of poor adherence or absorption
- For prophylaxis, target trough >0.7 mg/L, or random level 0.35 mg/L 48 h after starting therapy
- For treatment, target trough >1 mg/L
- In Ontario, it may be available through CHU Saine-Justine in Quebec (link to LTIG entry)
Safety
Adverse Events
- Liver toxicity
- Generally transient and asymptomatic and self-limited
- See also LiverTox
