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
=== Pharmacokinetics and Pharmacodynamics ===
*For treatment, target trough >1 mg/L

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


===Clinical Breakpoints===
===Clinical Breakpoints===
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! rowspan="2" |ECV (μg/mL)
! rowspan="2" |ECV (μg/mL)
! colspan="4" |Breakpoints (μg/mL)
! colspan="4" |Breakpoints (μg/mL)
! colspan="4" |Breakpoints (mm)
|-
|-
!S
!S
!SDD
!I
!I
!R
!S
!SDD
!SDD
!I
!R
!R
|-
|-
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|0.06
|0.06
|≤0.06
|≤0.06
| colspan="2" rowspan="9" |
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|≥0.12
|≥0.12
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|[[Candida dubliniensis]]
|[[Candida dubliniensis]]
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|[[Candida glabrata]]
|[[Candida glabrata]]
|2
|2
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|[[Candida guilliermondii]]
|[[Candida guilliermondii]]
|0.5
|0.5
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|[[Candida kefyr]]
|[[Candida kefyr]]
|0.25
|0.25
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|[[Candida krusei]]
|[[Candida krusei]]
|0.5
|0.5
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|[[Candida lusitaniae]]
|[[Candida lusitaniae]]
|0.12
|0.12
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|0.25
|0.25
|≤0.06
|≤0.06
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|≥0.12
|≥0.12
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|-
|-
|[[Candida tropicalis]]
|[[Candida tropicalis]]
|0.12
|0.12
|≤0.06
|≤0.06
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|≥0.12
|≥0.12
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|-
|-
|[[Cryptococcus neoformans]]
|[[Cryptococcus neoformans]]
|
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| colspan="8" rowspan="2" |
| colspan="4" rowspan="2" |
|-
|-
|[[Cryptococcus gattii]]
|[[Cryptococcus gattii]]
|
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|-
|[[Aspergillus flavus]]
|0.5
|—
| colspan="2" rowspan="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 [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 ==
== Safety ==

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