POSACONAZOLE
(Posanol)Standard Prescription
posaconazole __mg PO{NG} ___(frequency)
Dosages
Prophylaxis of invasive fungal infections
Children 6 mos - 12 yrs
Suspension: 4 mg/kg/dose PO TIDDelayed-Release Tablet: 5-7 mg/kg/dose PO BID x 1 day, then 5-7 mg/kg/dose PO daily. Round to nearest 100 mg.
Children >= 13 years and adults:
Suspension: 200 mg PO TIDPatients who cannot tolerate meals or nutritional supplements: 200 mg PO QID
Delayed-Release Tablet: 300 mg PO BID x 1 day, then 300 mg PO once daily thereafter
Treatment of Invasive Fungal Infections:
Children 6 mos -12 yrs
Suspension: 4.5-6 mg/kg/dose PO QID
Delayed-Release Tablet: 5-7 mg/kg/dose PO BID x 1 day, then 5-7 mg/kg/dose PO daily. Round to nearest 100 mg.
Children >= 13 years and adults:Suspension: 200 mg PO QID or 400 mg PO BID
Delayed-Release Tablet: 300 mg PO BID x 1 day, then 300 mg PO once daily thereafter
Mechanism of Action
Broad spectrum triazole antifungal.
Forms Supplied
Oral suspension: 40 mg/mL; 105 mL bottles
Delayed-release tablet: 100 mg
Delayed-release tablet: 100 mg
Comments
Use of posaconazole is approved only for:
Oral suspension should be taken with a high-fat meal (increases AUC ~4x relative to a fasted state), a regular meal or nutritional supplement (increases AUC ~2.6x), or with an acidic carbonated beverage (e.g. cola)(increases AUC ~0.7x).
There are multiple, serious/life-threatening drug interactions involving the cytochrome P450 enzymes; check drug interactions before initiating or stopping posaconazole therapy.May cause QT/QTc prolongation; caution when used with agents with a similar effect.
Dosage adjustment may be required for mild-to-severe hepatic impairment.
Serum posaconazole trough levels may be monitored to ensure targets for prophylaxis (? 0.7 mg/L) and treatment (? 1 mg/L) are met. Levels are processed every Thursday morning at St. Paul’s Hospital; please send levels by Tuesday. Steady state concentrations requires 6-10 days after onset of treatment or change in dose
- Prophylaxis of invasive fungal infections in: a. Neutropenic patients, where neutropenia is present for 10 days or longer, plus one of the following: i. Colonized with Aspergillus species, and/or receiving corticosteroids > 1mg/kg/day. ii. Acute Myeloid Leukemia or Myelodysplastic Syndrome receiving induction chemotherapy; iii. Acute lymphocytic leukemia iv. Burkitt's Lymphoma b. Allogeneic stem cell transplant patients with steroidrefractory graft-versus-host-disease treated with intensive immunosuppressive therapy.
- Treatment of invasive fungal infections, including zygomycetes, in leukemia/bone marrow transplant patients: a. Intolerant or resistant to other appropriate antifungals (e.g. amphotericin B, voriconazole, itraconazole, micafungin), or b. Where oral step down therapy is appropriate and cost effectiveVerify correct dosage form; delayed release tablet and oral suspension are not interchangeable. Treatment dose for the delayed release tablet has not been established.
Oral suspension should be taken with a high-fat meal (increases AUC ~4x relative to a fasted state), a regular meal or nutritional supplement (increases AUC ~2.6x), or with an acidic carbonated beverage (e.g. cola)(increases AUC ~0.7x).
There are multiple, serious/life-threatening drug interactions involving the cytochrome P450 enzymes; check drug interactions before initiating or stopping posaconazole therapy.May cause QT/QTc prolongation; caution when used with agents with a similar effect.
Dosage adjustment may be required for mild-to-severe hepatic impairment.
Serum posaconazole trough levels may be monitored to ensure targets for prophylaxis (? 0.7 mg/L) and treatment (? 1 mg/L) are met. Levels are processed every Thursday morning at St. Paul’s Hospital; please send levels by Tuesday. Steady state concentrations requires 6-10 days after onset of treatment or change in dose
References
6, 44, 93, 265, 266, 267, 268, 269, 270, 612
Last Edited
2023-04-17 02:02:39