Posaconazole Dosage

This dosage information may not include all the information needed to use Posaconazole safely and effectively. See additional information for Posaconazole.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Aspergillosis - Invasive

Prophylaxis: 200 mg orally three times a day

Duration of therapy should be based on recovery from immunosuppression or neutropenia.

Usual Adult Dose for Candidemia

Prophylaxis: 200 mg orally three times a day

Duration of therapy should be based on recovery from immunosuppression or neutropenia.

Usual Adult Dose for Oral Thrush

Oropharyngeal candidiasis:
Initial dose: 100 mg orally twice a day on the first day
Maintenance dose: 100 mg orally once a day for 13 days

Oropharyngeal candidiasis refractory to itraconazole and/or fluconazole: 400 mg orally twice a day

Duration of therapy should be based on the severity of the patient's underlying disease and clinical response.

Usual Pediatric Dose for Aspergillosis - Invasive

13 years or older:
Prophylaxis: 200 mg orally three times a day

Duration of therapy should be based on recovery from immunosuppression or neutropenia.

Usual Pediatric Dose for Candidemia

13 years or older:
Prophylaxis: 200 mg orally three times a day

Duration of therapy should be based on recovery from immunosuppression or neutropenia.

Usual Pediatric Dose for Oral Thrush

13 years or older:
Oropharyngeal candidiasis:
Initial dose: 100 mg orally twice a day on the first day
Maintenance dose: 100 mg orally once a day for 13 days

Oropharyngeal candidiasis refractory to itraconazole and/or fluconazole: 400 mg orally twice a day

Duration of therapy should be based on the severity of the patient's underlying disease and clinical response.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Mild to severe hepatic dysfunction (Child-Pugh class A, B, and C): No adjustment recommended.

Precautions

Concomitant administration of posaconazole with sirolimus, HMG-CoA reductase inhibitors primarily metabolized through CYP450 3A4 (e.g., atorvastatin, lovastatin, and simvastatin), ergot alkaloids, and CYP450 3A4 substrates that prolong the QT interval is contraindicated. Increased plasma levels of CYP450 3A4 substrates (such as pimozide and quinidine) may occur with coadministration of posaconazole, leading to QTc prolongation and rare occurrences of torsades de pointes.

Prolongation of the QT interval on the electrocardiogram has been reported in some azoles, including posaconazole. Additionally, rare cases of torsades de pointes have been reported with posaconazole. Posaconazole should not be administered with drugs that are known to prolong the QTc interval and are metabolized through CYP450 3A4 and should be administered with caution to patients with potentially proarrhythmic conditions. Potassium, magnesium, and calcium levels should be corrected prior to initiating posaconazole.

Hepatic reactions (e.g., mild to moderate elevations in ALT, AST, alkaline phosphatase, total bilirubin, and/or clinical hepatitis) have been reported in clinical trials. The liver function test elevations were generally reversible on discontinuation of therapy, and in some instances these tests normalized without drug interruption and rarely required drug discontinuation. Isolated cases of more severe hepatic reactions including cholestasis or hepatic failure including fatalities have been reported in patients with serious underlying medical conditions (e.g., hematologic malignancy) during treatment with posaconazole. These severe hepatic reactions were primarily seen in clinical trials in subjects receiving 800 mg daily (400 mg twice a day or 200 mg four times a day).

Liver function tests should be evaluated at the initiation of and during the course of posaconazole therapy. Patients who develop abnormal liver function tests during therapy should be monitored for the development of more severe hepatic injury. Management should include laboratory evaluation of hepatic function (particularly liver function tests and bilirubin). If clinical signs and symptoms consistent with liver disease develop that may be attributable to posaconazole, discontinuation of posaconazole must be considered.

Patients with severe renal dysfunction (CrCl less than 20 mL/min) or who develop severe diarrhea or vomiting should be closely monitored for breakthrough fungal infections.

Alternative treatment should be considered for patients who cannot eat a full meal or tolerate an oral nutritional supplement or an acidic carbonated beverage; otherwise, such patients should be monitored for breakthrough fungal infections.

If posaconazole is administered via a nasogastric tube, patients should be closely monitored for breakthrough fungal infections.

In general, coadministration of drugs that can decrease posaconazole plasma levels should be avoided unless the benefit outweighs the risk. If such drugs are necessary, patients should be closely monitored for breakthrough fungal infections.

Safety and effectiveness have not been established in pediatric patients less than 13 years of age.

Dialysis

Posaconazole is not removed by hemodialysis.

Other Comments

Each dose of posaconazole should be given during or within 20 minutes following a full meal. In patients unable to eat a full meal, each dose should be given with a liquid nutritional supplement or an acidic carbonated beverage (e.g., ginger ale).

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