Parenteral Manual

Posaconazole (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
POSANOL
Classification: 
Antifungal
Original Date: 
Frebruary 2017
Indications: 
  • Prevention of candida or aspergillosis in high-risk patients (e.g. prolonged neutropenia, post-stem-cell transplant patients)
  • Treatment of invasive aspergillosis refractory to amphotericin B.
  • Suspected or confirmed mucormycosis
Reconstitution and Stability: 
  • Supplied as 18 mg/mL clear, colourless-to-yellow injectable solution
  • 300 mg/vial preservative free - discard unused solution
  • Store vial in refrigerator; do not freeze
  • Bring to room temperature prior to dilution
  • Diluted solution stable 24 hours refrigerated
Compatibility: 

- Solutions Compatible:  D5W, 0.45% NaCl, 0.9% NaCl

- Y-site Compatible:  amikacin, caspofungin, ciprofloxacin, hydromorphone, levofloxacin, lorazepam, morphine, potassium chloride 20 mmol/L, vancomycin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES
Usual dilution:  1 - 2 mg/mL
Infusion time : Central line (preferred):  over 90 minutes

Peripheral line: over 30 minutes, one time, until CVL obtained

Infuse through 5 micron or smaller in-line filter
IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Adolescents / Adults: 300 mg IV q12h x 1 day, then 300 mg IV daily

Pediatrics (off-label dosing): 10 mg/kg/dose (max 400 mg) IV q12h x 1 day, then 10 mg/kg/dose (max 400 mg) IV once daily

Modification for kidney or liver dysfunction: avoid in patients with a GFR of less than 50
mL/min due to accumulation of the IV vehicle, SBECD ( Betadex Sulfobutyl Ether Sodium)

Potential hazards of parenteral administration: 
  • Peripheral administration: multiple peripheral infusions given through the same vein may result in infusion-site reactions.
  • Arrhythmia, especially in patients with prolonged QT syndrome or on other agents that prolong the QT interval
  • Hepatic dysfunction (increased AST, ALT, bilirubin, alk phos, clinical hepatitis)
  • Electrolyte abnormalities: hypokalemia, hypomagnesemia
  • Anemia, thrombocytopenia
  • Chills, fatigue, headache, abdominal pain, vomiting
     
Notes: 
  • Metabolized through CYP3A4; CYP3A4 inhibitor; avoid with CYP3A4 substrates that prolong the QT interval; check for drug interactions with any new medications
  • Monitor serum drug concentrations prior to 7th dose (steady state). There is some evidence that serum trough concentration at 3 days is predictive of the steady state levels.
  • Target trough concentration for treatment dosing: > 1 mcg/mL (at steady state) Contact pharmacy for details.
References: 
  • Posanol Product Monograph, Accessed 27Feb2017
  • Lexicomp online; accessed 27Feb2017
  • A. Teusink-Cross, IV Posaconazole in Pediatric patients. Powerpoint presentation at BMT Tandem Meeting February 2017.

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