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Triazole antifungal

Isavuconazole

Brand names: Cresemba

Isavuconazole is a broad-spectrum triazole antifungal (administered as the prodrug isavuconazonium) used for invasive aspergillosis and invasive mucormycosis.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits fungal cytochrome P450-dependent lanosterol 14-alpha-demethylase, blocking ergosterol synthesis and disrupting the fungal cell membrane.

Prescribing in practice

  • It is contraindicated with strong CYP3A4 inducers (and certain strong inhibitors such as ketoconazole) and in patients with familial short QT syndrome, as isavuconazole shortens the QT interval.
  • It is a substrate and moderate inhibitor of CYP3A4, so review co-medications carefully for interactions.
  • Hepatic adverse effects can occur; assess baseline liver function and use caution in significant hepatic impairment.

Monitoring

Monitor liver function tests at baseline and during treatment, and review concomitant medicines for clinically important interactions.

Counselling the patient

  • Report yellowing of the skin or eyes, dark urine, nausea or abdominal pain promptly.
  • Tell your clinician about all other medicines, as many interact with this antifungal.
  • Complete the full prescribed course to clear the infection.

Evidence & guidelines

Non-inferiority to voriconazole in invasive aspergillosis was shown in the SECURE trial.

Reference: NICE TA487/TA738; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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