What trough level is targeted for voriconazole in invasive aspergillosis?

Voriconazole trough 1-5.5 mg/L for invasive aspergillosis treatment; 5.5 mg/L associated with hepatotoxicity and neurotoxicity; check trough after day 4-5 (steady state); adjust dose by 50-100 mg increments.

What voriconazole loading dose is recommended?

IV: 6 mg/kg q12h for 2 doses then 4 mg/kg q12h; PO: 400 mg q12h day 1 then 200-300 mg q12h; CYP2C19 poor metabolizers require lower doses; no IV loading in renal failure (cyclodextrin vehicle accumulates) - use oral if CrCl <50.

What CYP2C19 genotype affects voriconazole levels significantly?

CYP2C19 poor metabolizers (*2/*2, *3/*3): 4-10x higher voriconazole levels vs normal metabolizers; CPIC recommends starting dose reduction for CYP2C19 PM; ultra-rapid metabolizers: higher doses needed; polymorphism explains much of the 10-fold inter-individual variability.

How should posaconazole be dosed for prophylaxis vs treatment?

Prophylaxis (oral solution): 200 mg TID with high-fat meal; tablet: 300 mg BD day 1, then 300 mg QD; treatment of invasive aspergillosis: tablets 300 mg BD ×1, then 300 mg QD; tablets/IV achieve superior exposure vs oral solution; TDM trough ≥0.7 mg/L prophylaxis, >1 mg/L treatment.

What antifungals are active against Mucormycosis?

Mucormycosis (Mucorales): liposomal AmB 5-10 mg/kg/day is first-line; isavuconazole (salvage/alternative); posaconazole (salvage); voriconazole has NO activity against Mucorales; surgical debridement is essential alongside antifungal; reverse immunosuppression.

Triazole Antifungal Dosing and TDM Calculator (Voriconazole/Posaconazole)

Calculates voriconazole loading and maintenance doses with CYP2C19 genotype consideration, posaconazole tablet vs solution dosing, and plasma trough level targets for invasive Aspergillosis and prophylaxis.

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Triazole Antifungal Dosing and TDM Calculator (Voriconazole/Posaconazole)

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Frequently Asked Questions

What trough level is targeted for voriconazole in invasive aspergillosis?

What voriconazole loading dose is recommended?

What CYP2C19 genotype affects voriconazole levels significantly?

How should posaconazole be dosed for prophylaxis vs treatment?

What antifungals are active against Mucormycosis?