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| Revision | Operations | |
|---|---|---|
| 07-31-24 by kaipe | current revision | |
| 07-31-24 by kaipe | ||
| 04-22-24 by kaipe | ||
| 04-22-24 by kaipe 4/22/24: Updated restriction language to match Epic builds | ||
| 07-20-23 by ripal121 | ||
| 02-16-21 by conan.macdougal... | ||
| 08-27-20 by conan.macdougal... | ||
| 08-20-20 by [email protected] | ||
| 08-20-20 by [email protected] | ||
| 08-12-20 by conan.macdougal... | ||
| 08-12-20 by conan.macdougal... | ||
| 08-12-20 by conan.macdougal... | ||
| 08-12-20 by conan.macdougal... | ||
| 08-12-20 by conan.macdougal... | ||
| 07-10-20 by [email protected] | ||
| 04-21-20 by ucsf_admin | ||
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.
IV formulation - Restriced to ID or Antimicrobial Stewardship except:
Inability to tolerate or absorb enteral medications and one of the following:
1) Prophylaxis against fungal infections in patients on the hematology/BMT/lung/heart transplant services with an intolerance of or contraindications to voriconazole
2) Suspected or documented serious fungal infection in the hematology/BMT or lung transplant services
3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient
PO formulation - Restricted to ID or Antimicrobial Stewardship except:
1) Prophylaxis against fungal infections in patients on the hematology/BMT/lung/heart transplant services with an intolerance of or contraindications to voriconazole
2) Suspected or documented serious fungal infection in the hematology/BMT or lung transplant services
3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient