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