TY - CHAP M1 - Book, Section TI - Extended-Spectrum Triazole Antifungals: Posaconazole and Voriconazoler A1 - MARTIN, KELLY E. A1 - ALEXANDER, MAURICE A1 - MULUNEH, BENYAM A2 - Cohen, Henry PY - 2015 T2 - Casebook in Clinical Pharmacokinetics and Drug Dosing AB - Voriconazole and posaconazole are broad-spectrum triazole antifungal agents. They decrease ergosterol synthesis by interfering with the lanosterol-14α-demethylase (P450 enzyme) activity leading to a malformation of the fungal cell membrane. These agents have activity against most yeasts, such as fluconazole-resistant Candida spp. and molds, such as Aspergillus spp. and Fusarium spp. Unlike voriconazole, posaconazole has activity against the Mucorales order.1,2 Posaconazole and voriconazole play a significant role in both the prevention and treatment of opportunistic invasive fungal infections, especially in immunocompromised patients. Because of its wide spectrum of activity, posaconazole is indicated for prophylaxis of invasive Aspergillus and Candida infections in patients who are at high risk of developing these infections due to prolonged immunosuppression after stem cell transplant or prolonged neutropenia after chemotherapy for a hematologic malignancy.1,3 Voriconazole is considered the drug of choice for treatment of most invasive aspergillosis infections.2,4 Voriconazole is also approved for use in nonneutropenic candidemia and as salvage therapy for Scedosporium apiospermum and Fusarium spp. infections.2 Although posaconazole is FDA-indicated for the treatment of refractory oropharyngeal candididasis, the suspension formulation also has positive data to support its use at higher doses for the treatment of other invasive fungal infections including mucormycosis and cryptococcal infections.5,6 Refer to Table 16-1 for FDA-approved treatment and prophylactic dosing recommendations for voriconazole and posaconazole. To date, the data for posaconazole delayed-release (DR) tablets and intravenous formulations are limited to prophylactic indications.1 Voriconazole and posaconazole therapeutic drug monitoring (TDM) can be utilized to improve patient outcomes and, in the case of voriconazole, to limit toxicity. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1112258954 ER -