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Triazole antifungal

Isavuconazole

Brand names: Cresemba

Adult dose

Dose: Loading 200mg every 8h for 6 doses, then 200mg OD; PO/IV bioequivalent
Route: PO/IV
Frequency: OD (after loading)

Clinical pearls

  • Invasive aspergillosis and mucormycosis
  • Unlike other azoles — does NOT prolong QT (and may shorten)

Contraindications

  • Concurrent strong CYP3A4 inducers
  • Familial short QT syndrome
  • Hypersensitivity

Side effects

  • Hepatotoxicity
  • GI upset
  • QT shortening (unique among azoles)
  • Hypokalaemia
  • Headache
  • Infusion reactions

Interactions

  • Strong CYP3A4 modulators
  • Tacrolimus/ciclosporin (raised levels)
  • Warfarin

Monitoring

  • LFTs
  • Drug levels (selected cases)
  • Trough levels of co-prescribed CYP3A4 substrates

Reference: BNF; NICE TA487/TA738; SmPC; https://bnf.nice.org.uk/drugs/isavuconazole/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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