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Posaconazole Dosage

Medically reviewed by Drugs.com. Last updated on Jul 14, 2021.

Applies to the following strengths: 40 mg/mL; 100 mg; 18 mg/mL

Usual Adult Dose for Aspergillosis - Invasive

PROPHYLAXIS OF INVASIVE ASPERGILLUS AND CANDIDA INFECTIONS:
IV:

  • Loading dose: 300 mg IV twice a day on the first day
  • Maintenance dose: 300 mg IV once a day thereafter

ORAL:
Delayed-Release Tablets:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Oral Suspension: 200 mg orally 3 times a day

Duration of Therapy:
  • Loading dose: 1 day
  • Maintenance dose: Should be based on recovery from immunosuppression or neutropenia

TREATMENT OF INVASIVE ASPERGILLOSIS:
IV:
  • Loading dose: 300 mg IV twice a day on the first day
  • Maintenance dose: 300 mg IV once a day, starting on the second day

ORAL:
Delayed-Release Tablets:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Duration of Therapy:
  • Loading dose: 1 day
  • Maintenance dose: 6 to 12 weeks (total)

Comments:
  • Switching between the IV and delayed-release tablets is acceptable for the treatment of invasive aspergillosis; a loading dose is not needed when switching between formulations.

Uses:
  • For the prophylaxis of invasive Aspergillus and Candida infections in high-risk, severely immunocompromised patients, such as hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or patients with hematologic malignancies with prolonged neutropenia from chemotherapy
  • For the treatment of invasive aspergillosis

Usual Adult Dose for Candidemia

PROPHYLAXIS OF INVASIVE ASPERGILLUS AND CANDIDA INFECTIONS:
IV:

  • Loading dose: 300 mg IV twice a day on the first day
  • Maintenance dose: 300 mg IV once a day thereafter

ORAL:
Delayed-Release Tablets:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Oral Suspension: 200 mg orally 3 times a day

Duration of Therapy:
  • Loading dose: 1 day
  • Maintenance dose: Should be based on recovery from immunosuppression or neutropenia

TREATMENT OF INVASIVE ASPERGILLOSIS:
IV:
  • Loading dose: 300 mg IV twice a day on the first day
  • Maintenance dose: 300 mg IV once a day, starting on the second day

ORAL:
Delayed-Release Tablets:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Duration of Therapy:
  • Loading dose: 1 day
  • Maintenance dose: 6 to 12 weeks (total)

Comments:
  • Switching between the IV and delayed-release tablets is acceptable for the treatment of invasive aspergillosis; a loading dose is not needed when switching between formulations.

Uses:
  • For the prophylaxis of invasive Aspergillus and Candida infections in high-risk, severely immunocompromised patients, such as hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or patients with hematologic malignancies with prolonged neutropenia from chemotherapy
  • For the treatment of invasive aspergillosis

Usual Adult Dose for Oral Thrush

Oral Suspension:
Oropharyngeal candidiasis:

  • Maintenance dose: 100 mg orally once a day thereafter
  • Loading dose: 1 day

Use: For the treatment of oropharyngeal candidiasis, including oropharyngeal candidiasis refractory to itraconazole and/or fluconazole

Usual Pediatric Dose for Aspergillosis - Invasive

PROPHYLAXIS OF INVASIVE ASPERGILLUS AND CANDIDA INFECTIONS:
IV:
2 to less than 18 years:

  • Maximum dose: 300 mg/dose
  • Maximum dose: 300 mg/dose

ORAL:
Delayed-Release Tablets:
2 to less than 18 years, weighing greater than 40 kg:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Oral Suspension:
13 to less than 18 years: 200 mg orally 3 times a day

Powder for Delayed-Release Oral Suspension:
2 to less than 18 years, weighing 10 to 40 kg:
  • Loading dose: 90 mg orally twice a day on the first day
  • Weight 12 to less than 17 kg:
  • Maintenance dose: 120 mg orally once a day thereafter
  • Loading dose: 150 mg orally twice a day on the first day
  • Weight 21 to less than 26 kg:
  • Maintenance dose: 180 mg orally once a day thereafter
  • Loading dose: 210 mg orally twice a day on the first day
  • Weight 36 to 40 kg:
  • Maintenance dose: 240 mg orally once a day thereafter

Duration of Therapy: Should be based on recovery from immunosuppression or neutropenia

TREATMENT OF INVASIVE ASPERGILLOSIS:
13 to less than 18 years (regardless of weight):
IV:
  • Loading dose: 300 mg IV twice a day on the first day
  • Maintenance dose: 300 mg IV once a day, starting on the second day

ORAL:
Delayed-Release Tablets:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Duration of Therapy:
  • Loading dose: 1 day
  • Maintenance dose: 6 to 12 weeks (total)

Comments:
  • The powder for delayed-release oral suspension is not recommended for use in patients weighing greater than 40 kg as the recommended dosage cannot be achieved.
  • Switching between the IV and delayed-release tablets is acceptable for the treatment of invasive aspergillosis; a loading dose is not needed when switching between formulations.

Uses:
  • For the prophylaxis of invasive Aspergillus and Candida infections in high-risk, severely immunocompromised patients, such as HSCT recipients with GVHD or patients with hematologic malignancies with prolonged neutropenia from chemotherapy
  • For the treatment of invasive aspergillosis in pediatric patients at least 13 years of age

Usual Pediatric Dose for Candidemia

PROPHYLAXIS OF INVASIVE ASPERGILLUS AND CANDIDA INFECTIONS:
IV:
2 to less than 18 years:

  • Maximum dose: 300 mg/dose
  • Maximum dose: 300 mg/dose

ORAL:
Delayed-Release Tablets:
2 to less than 18 years, weighing greater than 40 kg:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Oral Suspension:
13 to less than 18 years: 200 mg orally 3 times a day

Powder for Delayed-Release Oral Suspension:
2 to less than 18 years, weighing 10 to 40 kg:
  • Loading dose: 90 mg orally twice a day on the first day
  • Weight 12 to less than 17 kg:
  • Maintenance dose: 120 mg orally once a day thereafter
  • Loading dose: 150 mg orally twice a day on the first day
  • Weight 21 to less than 26 kg:
  • Maintenance dose: 180 mg orally once a day thereafter
  • Loading dose: 210 mg orally twice a day on the first day
  • Weight 36 to 40 kg:
  • Maintenance dose: 240 mg orally once a day thereafter

Duration of Therapy: Should be based on recovery from immunosuppression or neutropenia

TREATMENT OF INVASIVE ASPERGILLOSIS:
13 to less than 18 years (regardless of weight):
IV:
  • Loading dose: 300 mg IV twice a day on the first day
  • Maintenance dose: 300 mg IV once a day, starting on the second day

ORAL:
Delayed-Release Tablets:
  • Loading dose: 300 mg orally twice a day on the first day
  • Maintenance dose: 300 mg orally once a day, starting on the second day

Duration of Therapy:
  • Loading dose: 1 day
  • Maintenance dose: 6 to 12 weeks (total)

Comments:
  • The powder for delayed-release oral suspension is not recommended for use in patients weighing greater than 40 kg as the recommended dosage cannot be achieved.
  • Switching between the IV and delayed-release tablets is acceptable for the treatment of invasive aspergillosis; a loading dose is not needed when switching between formulations.

Uses:
  • For the prophylaxis of invasive Aspergillus and Candida infections in high-risk, severely immunocompromised patients, such as HSCT recipients with GVHD or patients with hematologic malignancies with prolonged neutropenia from chemotherapy
  • For the treatment of invasive aspergillosis in pediatric patients at least 13 years of age

Usual Pediatric Dose for Oral Thrush

Oral Suspension:
13 to less than 18 years:
Oropharyngeal candidiasis:

  • Maintenance dose: 100 mg orally once a day thereafter
  • Loading dose: 1 day

Use: For the treatment of oropharyngeal candidiasis, including oropharyngeal candidiasis refractory to itraconazole and/or fluconazole

Renal Dose Adjustments

IV:

  • Moderate or severe renal dysfunction (estimated glomerular filtration rate [eGFR] less than 50 mL/min): The injection should be avoided unless benefit justifies risk.

Oral:
  • Mild to severe renal dysfunction (eGFR up to 80 mL/min/1.73 m2): No adjustment recommended.

Comments:
  • IV: The IV vehicle, betadex sulfobutyl ether sodium (SBECD), is expected to accumulate in patients with moderate or severe renal dysfunction; serum creatinine levels should be monitored closely in these patients and if increases occur, switching to oral posaconazole therapy should be considered.
  • Oral: Patients with severe renal dysfunction (eGFR less than 20 mL/min/1.73 m2) should be monitored closely for breakthrough fungal infections.

Liver Dose Adjustments

Mild to severe liver dysfunction (Child-Pugh A, B, or C): No adjustment recommended.

Precautions

CONTRAINDICATIONS:

  • Known hypersensitivity to the active component or other azole antifungal agents
  • Coadministration with sirolimus
  • Coadministration with CYP450 3A4 substrates that prolong QT interval (e.g., pimozide, quinidine)
  • Coadministration with HMG-CoA reductase inhibitors primarily metabolized through CYP450 3A4 (e.g., atorvastatin, lovastatin, simvastatin)
  • Coadministration with ergot alkaloids (ergotamine, dihydroergotamine)
  • Powder for delayed-release oral suspension: Known/suspected hereditary fructose intolerance

Safety and efficacy have not been established in patients younger than 2 years.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is not removed by hemodialysis.

Other Comments

Administration advice:
IV:

  • Administer the injection through a 0.22-micron polyethersulfone (PES) or polyvinylidene difluoride (PVDF) filter.
  • Administer the injection via a central venous line, including a central venous catheter or peripherally inserted central catheter (PICC) by slow IV infusion over about 90 minutes; do not administer as an IV bolus injection.
  • If a central venous catheter is not available, the injection may be administered through a peripheral venous catheter by slow IV infusion over about 30 minutes only as a single dose before central venous line placement or to bridge the period when a central venous line is replaced or is in use for other IV therapy; when multiple dosing is needed, infuse via a central venous line.
ORAL:
  • Swallow tablets whole; do not divide, crush, or chew.
  • Oral Suspension:
  • Administer each dose during or within 20 minutes after a full meal.
  • In patients unable to eat a full meal, and the delayed-release tablets or injection are not options, administer each dose with a liquid nutritional supplement or an acidic carbonated beverage (e.g., ginger ale).
  • If this drug is administered via a nasogastric tube, monitor patients closely for breakthrough fungal infections.
  • Powder for Delayed-Release Oral Suspension: Consult the manufacturer product information (Instructions for Use) for details regarding administration.
  • Administer the reconstituted suspension within 1 hour; discard the unused portion of the prepared product.
  • This formulation is not recommended for use in patients weighing greater than 40 kg as the recommended dosage cannot be achieved; the maximum dose that can be accurately withdrawn from the mixing cup after reconstitution is 240 mg.
  • In vial: Store refrigerated at 2C to 8C (36F to 46F); equilibrate refrigerated vial to room temperature before preparation.
  • Delayed-release tablets: Store at 20C to 25C (68F to 77F); excursions permitted to 15C to 30C (59F to 86F).
  • Powder for delayed-release oral suspension: Store entire kit at 20C to 25C (68F to 77F); excursions permitted to 15C to 30C (59F to 86F) in a clean, dry place; do not open foil packet until ready for use.

Reconstitution/preparation techniques:
  • IV: The manufacturer product information should be consulted; final concentration should be between 1 and 2 mg/mL.
  • Powder for delayed-release oral suspension: The manufacturer product information (Instructions for Use) should be consulted for details regarding preparation; the provided notched tip syringes must be used for preparation and administration (design prevents aggregation of the suspension).

IV compatibility:
  • This drug can be infused at the same time through the same IV line (or cannula) with these compatible diluents.
  • Any drug products not listed above should not be coadministered through the same IV line (or cannula).

Monitoring:
  • General: For breakthrough fungal infections (e.g., patients with severe diarrhea/vomiting using an oral formulation, patients weighing more than 120 kg [particularly when using the oral suspension])
  • Hepatic: Liver tests (at the start of and during therapy); for more severe liver injury in patients with abnormal liver tests (during therapy); hepatic function, especially liver tests and bilirubin, for patient management (during therapy)
  • Metabolic: Electrolyte disturbances, especially involving potassium, magnesium, or calcium levels (before and during therapy)
  • Renal: Serum creatinine levels in patients with moderate or severe renal dysfunction using the injection

Patient advice:
  • Read the US FDA-approved patient information (Patient Information and Instructions for Use).
  • Notify physician at once if severe diarrhea or vomiting develops or if you notice a change in heart rate or heart rhythm.
  • Inform physician immediately if signs/symptoms of liver problems (e.g., itching, nausea/vomiting, yellowing of eyes/skin, feeling more tired than usual, influenza-like symptoms) develop.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.