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 |
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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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| + | === Pharmacokinetics and Pharmacodynamics === |
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| − | *For treatment, target trough >1 mg/L |
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| + | |||
| + | * Generally distributes well, with the notable exception of non-inflamed brain |
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===Clinical Breakpoints=== |
===Clinical Breakpoints=== |
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! rowspan="2" |ECV (μg/mL) |
! rowspan="2" |ECV (μg/mL) |
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! colspan="4" |Breakpoints (μg/mL) |
! colspan="4" |Breakpoints (μg/mL) |
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| − | ! colspan="4" |Breakpoints (mm) |
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!S |
!S |
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| − | !SDD |
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!I |
!I |
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| − | !R |
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| − | !S |
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!SDD |
!SDD |
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| − | !I |
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!R |
!R |
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|0.06 |
|0.06 |
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|≤0.06 |
|≤0.06 |
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| + | | 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]] |
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|2 |
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|[[Candida guilliermondii]] |
|[[Candida guilliermondii]] |
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|0.5 |
|0.5 |
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|[[Candida kefyr]] |
|[[Candida kefyr]] |
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|0.25 |
|0.25 |
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|[[Candida krusei]] |
|[[Candida krusei]] |
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|0.5 |
|0.5 |
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|[[Candida lusitaniae]] |
|[[Candida lusitaniae]] |
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|0.12 |
|0.12 |
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|0.25 |
|0.25 |
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|≤0.06 |
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|≥0.12 |
|≥0.12 |
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|[[Candida tropicalis]] |
|[[Candida tropicalis]] |
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|0.12 |
|0.12 |
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|≤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=" |
+ | | colspan="4" rowspan="2" | |
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|[[Cryptococcus gattii]] |
|[[Cryptococcus gattii]] |
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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 == |
== Safety == |
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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
