Posaconazole: Difference between revisions

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== Background ==
==Therapeutic Drug Monitoring==


* Azole antifungal
*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 ===
=== Pharmacokinetics and Pharmacodynamics ===

* Generally distributes well, with the notable exception of non-inflamed brain

===Clinical Breakpoints===
{| class="wikitable"
{| class="wikitable"
!Species
! rowspan="2" |Species
!ECV (mcg/mL)
! rowspan="2" |ECV (μg/mL)
! colspan="4" |Breakpoints (μg/mL)
|-
|-
!S
|C. albicans
!I
!SDD
!R
|-
|[[Candida albicans]]
|0.06
|0.06
|≤0.06
| colspan="2" rowspan="9" |
|≥0.12
|-
|[[Candida dubliniensis]]
|
|
|
|-
|-
|C. glabrata
|[[Candida glabrata]]
|2
|2
|
|
|-
|-
|[[Candida guilliermondii]]
|C. parapsilosis
|0.5
|
|
|-
|[[Candida kefyr]]
|0.25
|0.25
|
|
|-
|-
|[[Candida krusei]]
|C. tropicalis
|0.5
|
|
|-
|[[Candida lusitaniae]]
|0.12
|0.12
|
|
|-
|-
|[[Candida parapsilosis]]
|C. krusei
|0.5
|0.25
|≤0.06
|≥0.12
|-
|-
|[[Candida tropicalis]]
|C. lusitaniae
|0.12
|0.12
|≤0.06
|≥0.12
|-
|-
|[[Cryptococcus neoformans]]
|C. guilliermondii
|
| colspan="4" rowspan="2" |
|-
|[[Cryptococcus gattii]]
|
|-
|[[Aspergillus flavus]]
|0.5
|0.5
|—
| colspan="2" rowspan="5" |
|—
|-
|-
|[[Aspergillus fumigatus]]
|C. kefyr
|0.25
|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 [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 ==

=== Adverse Events ===

* Liver toxicity
** Generally transient and asymptomatic and self-limited
** See also [https://www.ncbi.nlm.nih.gov/books/NBK548934/ LiverTox]

[[Category:Triazoles]]
[[Category:Triazoles]]

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