Posaconazole

C difficile risk
N/A
Oral Bioavailability
Excellent
Cost
$150-300/day

Dosing

  • Requires AMS review within 72 hours. See below for more information.

  • Should be reserved for specific cases where voriconazole (or alternative anti-fungal) cannot be used, is not tolerated, or is not covered by patient’s private drug insurance.

Oral suspension and delayed release tablets are NOT interchangeable (dosage differences)

  • Prophylaxis: 200 mg (5 mL) po TID- Treatment: 200 mg po QID or 400 mg po BID

  • Prophylaxis/treatment: 300 mg BID on Day 1, then 300 mg daily

No renal adjustment required

General Information

Treatment or prophylaxis of invasive fungal infections (particularly Aspergillus sp.) in patients at high-risk of infection including allogeneic stem cell transplant recipients, patients with hematological malignancies undergoing chemotherapy (e.g. acute myeloid leukemia), or patients with graft-vs-host disease receiving prednisone 1mg/kg/day or more, with

  • contraindications to voriconazole,

  • intolerance to voriconazole, or

  • patients previously established, or who will be established, on posaconazole therapy in the outpatient setting (i.e. due to drug plan coverage restrictions).

Treatment of invasive fungal infections (e.g. Mucormycosis) where alternatives are ineffective or not tolerated.

  • Liver enzymes

  • Electrolytes and extended lytes

  • Creatinine

  • CBC

  • QTc

  • QTc prolongation

  • Hepatitis

  • Nausea, vomiting, abdominal pain

  • Electrolyte imbalance: K, Mg, Ca

  • Headache

  • Chills

  • Rash

  • Edema

  • Anemia, Thrombocytopenia

  • Adrenal insufficiency (with >6 months therapy)

  • Nephrotoxicity (with >6 months therapy)

CHECK FOR INTERACTIONS

  • Significant drug-drug interactions via CYP3A4 inhibition.

  • Dose adjustments may be required (e.g. cyclosporine).

Suspension and delayed-release tablets are NOT interchangeable: Verify dose.

The suspension should be administered with a meal to optimize absorption (oral suspension). Delayed-release tablets may be taken with or without food.

If administered via a feeding tube, concomitant feeds should NOT be held before/after suspension administration. Nasogastric administration results in decreased absorption; monitor patient closely if this route is used.

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