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) | 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
- Increases levels of sirolimus and tacrolimus
- Increases levels of cyclosporine
- Contraindicated with carbamazepine
