Abstract
Posaconazole, a triazole antifungal agent, displays a highly variable pharmacokinetic profile due in part to the oral solution, the only currently available dosage form. Posaconazole activity appears to be dose-dependent and clinical outcomes correlate with steady-state serum trough concentrations and area under the concentration curve (AUC) over minimum inhibitory concentration (MIC) ratios. Therapeutic drug monitoring (TDM) has been recommended to help overcome the unpredictable nature of the drug. The impact of obesity of posaconazole pharmacokinetics and the use of TDM in this population has not been well described; however, limited data demonstrate increased weight correlates with lower serum concentrations and reduced drug exposure. We describe the use of TDM in an obese man, 12 months status post hematopoietic stem-cell transplant (HSCT), receiving posaconazole therapy for a presumed invasive fungal infection (IFI).
Highlights
Over the last 20 years, obesity in the United States has increased at an alarming rate
Posaconazole activity appears to be dose-dependent and clinical outcomes correlate with steady-state serum trough concentrations and area under the concentration curve (AUC) over minimum inhibitory concentration (MIC) ratios
We describe the use of Therapeutic drug monitoring (TDM) in an obese man, 12 months status post hematopoietic stem-cell transplant (HSCT), receiving posaconazole therapy for a presumed invasive fungal infection (IFI)
Summary
Over the last 20 years, obesity in the United States has increased at an alarming rate. Appropriate drug therapy in the obese population can present a difficult challenge for clinicians, as many drugs, including antimicrobials, require an altered dosing modality due to significant changes in pharmacokinetic parameters [2]. Serum concentrations are reduced in patients receiving concomitant acid reducing agents and in the presence of concurrent states such as diarrhea and mucositis [4]. The impact of obesity of posaconazole pharmacokinetics and the use of TDM in this population has not been well described; limited data demonstrate increased weight correlates with lower serum concentrations and reduced drug exposure [7,8]. We describe the use of TDM in an obese man, 12-month status post hematopoietic stem-cell transplant (HSCT), receiving posaconazole therapy for a presumed invasive fungal infection (IFI)
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