Isavuconazole

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Background

Mechanism of Action

  • Azole antifungal that inhibits lanosterol 14-α demethylase in the peptidoglycan synthesis pathway

Spectrum of Activity

Breakpoints

Species ECOFF (mg/L) Breakpoints (μg/mL) Breakpoints (mm)
S I SDD R S I SDD R
Candida albicans
Candida glabrata
Candida krusei
Candida parapsilosis
Candida tropicalis
Cryptococcus neoformans
Cryptococcus gattii
Aspergillus flavus 2
Aspergillus fumigatus 2 ≤1 >1
Aspergillus nidulans 0.25 ≤0.25 >0.25
Aspergillus niger 4
Aspergillus terreus 1 ≤1 >1

Dosing

  • Isavuconazole 200 mg IV tid for 6 doses followed by 200 mg IV daily

Renal Dosing

  • No adjustment needed

Hepatic Dosing

  • No adjustment needed

Safety

Adverse Drug Reactions

  • Nausea, vomiting, diarrhea
  • Elevated liver enzymes
    • Generally transient ALT elevation that does not require change in therapy
    • May also include severe cholestatic or hepatocellular enzyme rises within the first few months of therapy
    • See also LiverTox
  • Hypokalemia

Drug-Drug Interactions