Posaconazole

INTRODUCTION

Indications

Prevention of invasive Aspergillus and Candida infections in severely immunocompromised patients. Treatment of oropharyngeal candidiasis (including candidiasis unresponsive to itraconazole or fluconazole).

Action

Blocks ergosterol synthesis, a major component of fungal plasma membrane. Therapeutic Effects: Fungistatic/fungicidal action against susceptible fungi.

Adverse Reactions/Side Effects

GI: HEPATOCELLULAR DAMAGE, diarrhea, nausea, vomiting. Endo: adrenal insufficiency. Metab: ALLERGIC RECTIONS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician or nursing staff immediately.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor and report signs of adrenal insufficiency, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient to take this drug as directed for the full course of treatment even if feeling better.

• Instruct patient to report other troublesome side effects such as prolonged or severe nausea, vomiting, or diarrhea.

Pharmacokinetics

Absorption: Well absorbed following oral administration; absorption is optimized by food.

Distribution: Extensive extravascular distribution and penetration into body tissues.

Protein Binding: >98%.

Metabolism and Excretion: Some metabolism via UDP glucuronidation; 66% eliminated unchanged in feces, 13% in urine (mostly as metabolites).

Half-life: 35 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent use of pimozide or quinidine (↑ risk of serious arrhythmias); Concurrent use of ergot alkaloids (↑ risk of ergotism).

Use Cautiously in: History of/predisposition to QTc prolongation, including congenital QTc prolongation, concurrent medications which prolong QTc, high cumulative anthracycline history, or electrolyte abnormalities (hypokalemia, hypomagnesemia); correct preexisting abnormalities prior to administration; Hypersensitivity to other azole antifungals; Hepatic impairment; Severe diarrhea, vomiting, or renal impairment (monitor for breakthrough fungal infections); OB: Use only in pregnancy or lactation if maternal benefit outweighs risk to child; Pedi: Safe use in children ...