Isavuconazole
From IDWiki
Background
Mechanism of Action
- Azole antifungal that inhibits lanosterol 14-α demethylase in the peptidoglycan synthesis pathway
Spectrum of Activity
- Active against Candida, Cryptococcus, Aspergillus including Aspergillus flavus, Aspergillus fumigatus, and Aspergillus niger, and Mucorales
- Indications include Chromoblastomycosis, Cladophialophora, Coccidioides immitis
Breakpoints
| Species | ECOFF (mg/L) | Breakpoints (μg/mL) | ||
|---|---|---|---|---|
| S | ATU | R | ||
| Candida albicans | ||||
| Candida glabrata | ||||
| Candida krusei | ||||
| Candida parapsilosis | ||||
| Candida tropicalis | ||||
| Cryptococcus neoformans | ||||
| Cryptococcus gattii | ||||
| Aspergillus flavus | 2 | ≤1 | 2 | >2 |
| Aspergillus fumigatus | 2 | ≤1 | 2 | >2 |
| Aspergillus nidulans | 0.25 | ≤0.25 | — | >0.25 |
| Aspergillus niger | 4 | — | — | — |
| Aspergillus terreus | 1 | ≤1 | — | >2 |
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
- Increases levels of sirolimus and tacrolimus
- Increases levels of cyclosporine
- Contraindicated with carbamazepine
