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Posaconazole liquid vs tablet formulation in lung transplant recipients

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Posaconazole is an extended‐spectrum triazole antifungal used in the treatment and prophylaxis of Aspergillus infections. It is available as oral suspension (POS‐Liq) and delayed‐release tablets (POS‐Tab). The aim of this longitudinal, retrospective study was to compare the clinical effectiveness, toxicity and pharmacokinetics of POS‐Liq vs POS‐Tab in lung transplant recipients (LTx‐recipients), who were treated with both formulations subsequently. Twenty‐four consecutive LTx‐recipients with 191 documented posaconazole trough levels (PTLs) for POS‐Liq or POS‐Tab were included. The administered daily doses were 300 mg for POS‐Tab and 600 mg (prophylaxis) or 800 mg (therapy) for POS‐Liq. Target PTLs were ≥700 ng/mL (prophylaxis) and ≥1250 ng/mL (therapy). The overall prophylactic and therapeutic response rates were 78% and 67%, respectively. No cases of hepatotoxicity or QT‐prolongation were observed with either formulation. The achieved target PTLs were tripled under POS‐Tab compared to POS‐Liq with fewer risk factors for sub‐therapeutic PTLs. Concomitant administration of POS‐Tab significantly reduced the tacrolimus concentration‐to‐dose ratio (= .001). We suggest the use of POS‐Tab is appropriate for prophylaxis and therapy of Aspergillus infections in LTx‐recipients, since POS‐Tab displayed more reliable PTLs with no added adverse events. However, we recommend regular drug monitoring for POS‐Liq and for therapy with POS‐Tab and that immunosuppressant levels are monitored closely when the posaconazole formulation is switched.
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Keywords: antifungal agents; dosage form; invasive fungal infection; lung transplantation; posaconazole; therapeutic drug monitoring

Document Type: Research Article

Publication date: March 1, 2018

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