Posaconazole

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Dosing Notes
All Indications (IV or Delayed-release tablet) 300 mg IV/PO q12h x 2 doses, then 300 mg IV/PO q24h No renal dose adjustment (avoid IV if possible in patients with CrCl <50 mL/min due to accumulation of IV vehicle)

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Dosing Notes
All Indications (IV or Delayed-release tablet) 300 mg IV/PO q12h x 2 doses, then 300 mg IV/PO q24h No dose adjustment in hemodialysis

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Take with food.  Posaconazole SOLUTION has more frequent dosing, low bioavailability, and significant food restrictions.  Do not substitute SOLUTION for TABLETS or IV without discussion with ID Pharmacy.

Review medications for potential drug interactions.

Posaconazole trough levels should be obtained in most patients, whether receiving the agent for prophylaxis or treatment of fungal infections.  Trough samples should be obtained 5-7 days after: 
-start of therapy
-change in dose
-change in route of administration
-change in potentially interacting drugs

See UCSF Lab Posaconazole Recommendations  for specifics of monitoring.

Unrestricted indications:

1) Prophylaxis against fungal infections in patients on the hematology/oncology/BMT service or lung transplant service with intolerance of or contraindications to voriconazole

2) Suspected or documented fungal pneumonia in the hematology/BMT/lung transplant services

3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

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