黴菌感染
Invasive Aspergillosis: For patients ≥13 years of age)
Prophylaxis against invasive fungal infections: For patients ≥2 years of age and >40 kg; Prophylaxis of invasive Aspergillus and Candida infections in severely immunocompromised patients

Antifungal Agent, Azole Derivative
Interferes with fungal cytochrome P450 (lanosterol-14α-demethylase) activity, decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting fungal cell membrane formation.

Absorption:
Bioavailability: 54%
Distribution:
Protein binding, Albumin: >98%
Metabolism:
1. Hepatic: primarily glucuronidation, inhibitor of CYP3A4 (strong); Renal: 13%
2. Elimination Half Life: 26 to 31 hours
Excretion:
1. Feces 71% (~66% as unchanged drug)
2. Urine 13% (<0.2% as unchanged drug)

1. Concomitant use with ergot alkaloids, HMG-CoA reductase inhibitors primarily metabolized by CYP3A4 (eg, atorvastatin, lovastatin, and simvastatin), sirolimus, or CYP3A4 substrates that prolong the QT interval (eg, pimozide and quinidine)
2. Hypersensitivity to posaconazole or other azole antifungals

C (FDA)

Infant risk cannot be ruled out.

1. Endocrine metabolic: Hypokalemia
2. Gastrointestinal: Diarrhea, Nausea, Vomiting
3. Neurologic: Headache
4. Other: Fever
5. Cardiovascular: Prolonged QT interval, Torsades de pointes
6. Hepatic: Cholestasis, Liver failure

Aspergillosis:
1. Chronic cavitary pulmonary: 300 mg twice daily for 2 doses, then 300 mg once daily; duration ≥6 months, some require prolonged therapy
2. Invasive: 300 mg twice daily for 2 doses, then 300 mg once daily; minimum duration 6-12 weeks
Prophylaxis against invasive fungal infections:
300 mg twice daily for 2 doses, then 300 mg once daily

1. eGFR 20-80 mL/minute/1.73 m2: No dosage adjustment necessary.
2. eGFR <20 mL/minute/1.73 m2: No dosage adjustment necessary; however, monitor for breakthrough fungal infections due to variability in posaconazole exposure.

1. Child-Pugh class A, B, or C: No dosage adjustment necessary
2. Hepatotoxicity during treatment: There are no dosage adjustments provided in the manufacturer's labeling; consider discontinuing therapy.