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Posaconazole

[Posaconazole photo]

KEY POINTS

  • Posaconazole (Noxafil) is a triazole antifungal that works by inhibiting the synthesis of ergosterol
    • Ergosterol is the primary sterol in the fungal cell wall
  • Has activity against fungi such as Candida species, Aspergillus species, and zygomycetes
  • FDA-approved for:
    • Prophylaxis versus invasive aspergillosis in severely immunocompromised patients
    • Oropharyngeal candidiasis
    • Prophylaxis versus invasive candidiasis in severely immunocompromised patients
  • Available oral and injectable
    • The delayed-release tablets and oral suspensions are not interchangeable directly, dosage must be adjusted
  • Dose and frequency vary depending on the indication
    • Usually dosed in either 200mg, 300mg, or 400mg per dose
    • The IV formulation is generally avoided for creatinine clearance below 50 mL/min, because the vehicle the drug is provided in can accumulate and cause toxicity
  • Drug levels are frequently monitored to ensure adequate absorption
    • The delayed-release tablet should be taken with food
    • The oral suspension should be given within 20 minutes of a full meal
  • Beware drug-drug interactions, posaconazole use is contraindicated with many other drugs
  • Some adverse reactions to beware include: hypokalemia, diarrhea, nausea, headache, fever, prolonged QT interval, and liver toxicity

RESOURCES

  • Posaconazole Package Insert (oral solution)
  • Posaconazole Package Insert (delayed-release tablet)
  • Posaconazole Package Insert (intravenous)
  • 2016 IDSA Aspergillus Guideline
  • 2016 IDSA Candidiasis Guideline
  • 2014 Therapeutic Drug Monitoring of Antifungal Agents – Guidelines from the British Society for Medical Microbiology
  • 2016 Review of Therapeutic Drug Monitoring of Posaconazole
  • 2006 Pharmacology of Systemic Antifungal Agents

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Study Guide

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