Isavuconazole

KEY POINTS

• Isavuconazole (isavuconazonium sulfate, Cresemba) is an Az0le antifungal that works by inhibiting the synthesis of ergosterol, a key part of the fungal cell wall
  • Is administered as isavuconazonium sulfate, which is a prodrug, converting to isavuconazole in the blood
• Has activity versus a number of fungal pathogens, with notable uses for invasive aspergillosis and invasive mucormycosis
• Available as oral and injectable
  • Intravenous product should not be infused via bolus
• Dose in milligrams of isavuconazonium sulfate
  • No dosage adjustment provided by package insert for renal or hepatic impairment, but use with caution in child-pugh class C
• Beware drug-drug interactions
  • Substrate: CYP-3A4 (major)
  • Inhibitor: CYP-2C19 (weak), CYP2C9 (weak), CYP-3A4 (moderate), OCT2
  • Inducer: CYP-2B6 (weak), CYP-2C9 (weak/moderate)
• Beware hepatic effects and infusion-mediated reactions
• Some of the more frequent adverse effects to beware include peripheral edema, headache, insomnia, hypokalemia, nausea, vomiting, diarrhea, abdominal pain, constipation, increased liver enzymes, dyspnea and cough

RESOURCES

• Isavuconazole Package Insert
• Isavuconazole: A New Triazole Antifungal Agent (CID, 2015)
• IDSA Aspergillosis Guidelines