Posaconazole: Difference between revisions
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== Background == |
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== Therapeutic Drug Monitoring == |
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* Measure trough 7 days after starting or adjusting dose, or adjusting interacting medications, or concerns of poor adherence or absorption |
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* Azole antifungal |
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* For prophylaxis, target trough >0.7 mg/L, or random level 0.35 mg/L 48 h after starting therapy |
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* For treatment, target trough >1 mg/L |
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=== Pharmacokinetics and Pharmacodynamics === |
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* Generally distributes well, with the notable exception of non-inflamed brain |
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===Clinical Breakpoints=== |
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{| class="wikitable" |
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! rowspan="2" |Species |
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! rowspan="2" |ECV (μg/mL) |
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! colspan="4" |Breakpoints (μg/mL) |
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|- |
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!S |
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!I |
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!SDD |
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!R |
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|- |
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|[[Candida albicans]] |
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|0.06 |
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|≤0.06 |
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| colspan="2" rowspan="9" | |
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|≥0.12 |
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|- |
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|[[Candida dubliniensis]] |
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| |
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| |
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| |
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|- |
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|[[Candida glabrata]] |
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|2 |
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| |
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| |
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|- |
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|[[Candida guilliermondii]] |
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|0.5 |
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| |
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| |
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|- |
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|[[Candida kefyr]] |
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|0.25 |
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| |
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| |
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|- |
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|[[Candida krusei]] |
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|0.5 |
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| |
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| |
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|- |
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|[[Candida lusitaniae]] |
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|0.12 |
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| |
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| |
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|- |
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|[[Candida parapsilosis]] |
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|0.25 |
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|≤0.06 |
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|≥0.12 |
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|- |
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|[[Candida tropicalis]] |
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|0.12 |
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|≤0.06 |
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|≥0.12 |
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|- |
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|[[Cryptococcus neoformans]] |
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| |
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| colspan="4" rowspan="2" | |
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|- |
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|[[Cryptococcus gattii]] |
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| |
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|- |
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|[[Aspergillus flavus]] |
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|0.5 |
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|— |
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| colspan="2" rowspan="5" | |
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|— |
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|- |
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|[[Aspergillus fumigatus]] |
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|0.25 |
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|≤0.125 |
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|>0.25 |
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|- |
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|[[Aspergillus nidulans]] |
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|0.5 |
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|— |
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|— |
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|- |
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|[[Aspergillus niger]] |
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|0.5 |
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|— |
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|— |
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|- |
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|[[Aspergillus terreus]] |
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|0.25 |
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|≤0.125 |
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|>0.25 |
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|} |
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== 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 |
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*In Ontario, it may be available through [https://www.chusj.org/labotest/accueil CHU Saine-Justine] in Quebec ([https://chusj.omni-assistant.net/labo/AnalysisRegistry/AnalysisView.aspx?PK_Analysis=446 link to LTIG entry]) |
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== Safety == |
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=== Adverse Events === |
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* Liver toxicity |
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** Generally transient and asymptomatic and self-limited |
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** See also [https://www.ncbi.nlm.nih.gov/books/NBK548934/ LiverTox] |
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[[Category:Triazoles]] |
[[Category:Triazoles]] |
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Latest revision as of 15:00, 22 October 2024
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
