title: Serum posaconazole levels among haematological cancer patients taking extended release tablets is affected by body weight and diarrhoea: single centre retrospective analysis.
abstract: The posaconazole extended release tablet formulation was developed to improve bioavailability relative to the oral suspension. Therapeutic drug monitoring has been used to optimise posaconazole dosing to achieve a target trough level ≥0.7 μg ml(-1). We retrospectively evaluated 28 patients with haematological malignancies who received posaconazole tablets for antifungal prophylaxis. Posaconazole serum trough levels were obtained 5 days after initiation of therapy. Mean trough level was 1.19 ± 0.63 μg ml(-1), and 71% achieved a trough level ≥0.7 μg ml(-1). Diarrhoea was associated with lower mean trough levels (0.65 ± 0.08 μg ml(-1) vs. 1.31 ± 0.13 μg ml(-1)), P = 0.002. Mean trough levels were lower in patients ≥90 kg (0.74 ± 0.09 μg ml(-1)) vs. <90 kg (1.32 ± 0.14 μg ml(-1)), P = 0.002 and in patients with body mass index (BMI) ≥30 (0.89 ± 0.13 μg ml(-1)) vs. BMI <30 (1.29 ± 0.14 μg ml(-1)), P = 0.05. Posaconazole delayed release tablets attain appropriate trough levels in most patients, but patients with a higher weight and those experiencing diarrhoea are more likely to have lower levels.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Marisa H
authors.initials: MH
authors.lastname: Miceli
authors.affiliation: Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perissinotti
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.|Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Couriel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001682:Biological Availability; D015992:Body Mass Index; D001835:Body Weight; D003692:Delayed-Action Preparations; D003967:Diarrhea / Q000150:complications*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control; D012189:Retrospective Studies; D013607:Tablets; D014230:Triazoles / Q000008:administration & dosage* / Q000097:blood* / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D003692:Delayed-Action Preparations; D013607:Tablets; D014230:Triazoles; C101425:posaconazole
keywords: Posaconazole tablets; antifungals; therapeutic drug monitoring