Posaconazole: Difference between revisions

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== Background ==
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==Therapeutic Drug Monitoring==
  
   
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* Azole antifungal
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*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
  
   
−
=== Epidemiologic Cutoff Values ===
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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===
 
{| class="wikitable"
  
{| class="wikitable"
−
!Species
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! rowspan="2" |Species
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!ECV (mcg/mL)
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! rowspan="2" |ECV (μg/mL)
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! colspan="4" |Breakpoints (μg/mL)
 
|-
  
|-
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!S
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|C. albicans
  
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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]]
 
|0.06
  
|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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|
  +
|
  +
|
 
|-
  
|-
−
|C. glabrata
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|[[Candida glabrata]]
 
|2
  
|2
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|
  +
|
 
|-
  
|-
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|[[Candida guilliermondii]]
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|C. parapsilosis
  
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|0.5
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|
  +
|
  +
|-
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|[[Candida kefyr]]
 
|0.25
  
|0.25
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|
  +
|
 
|-
  
|-
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|[[Candida krusei]]
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|C. tropicalis
  
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|0.5
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|
  +
|
  +
|-
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|[[Candida lusitaniae]]
 
|0.12
  
|0.12
  +
|
  +
|
 
|-
  
|-
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|[[Candida parapsilosis]]
−
|C. krusei
  
−
|0.5
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|0.25
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|≤0.06
  +
|≥0.12
 
|-
  
|-
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|[[Candida tropicalis]]
−
|C. lusitaniae
  
 
|0.12
  
|0.12
  +
|≤0.06
  +
|≥0.12
 
|-
  
|-
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|[[Cryptococcus neoformans]]
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|C. guilliermondii
  
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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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|[[Aspergillus flavus]]
 
|0.5
  
|0.5
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|—
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| colspan="2" rowspan="5" |
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|—
 
|-
  
|-
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|[[Aspergillus fumigatus]]
−
|C. kefyr
  
 
|0.25
  
|0.25
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|≤0.125
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|>0.25
  +
|-
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|[[Aspergillus nidulans]]
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|0.5
  +
|—
  +
|—
  +
|-
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|[[Aspergillus niger]]
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|0.5
  +
|—
  +
|—
  +
|-
  +
|[[Aspergillus terreus]]
  +
|0.25
  +
|≤0.125
  +
|>0.25
 
|}
  
|}
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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
  +
*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])
  +
  +
== 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]
  +
 
[[Category:Triazoles]]
  
[[Category:Triazoles]]

Latest revision as of 11:00, 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
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