Posaconazole in prophylaxis and treatment of invasive fungal infections: a pharmacokinetic, pharmacodynamic and clinical evaluation.

INTRODUCTION: Invasive fungal infections (IFIs) are associated with a high morbidity and mortality and their incidence is rising. Posaconazole is a triazole antifungal drug that has an important place in the prophylaxis and salvage treatment of these infections. AREAS COVERED: This review focuses on the efficacy, safety, pharmacokinetics, pharmacodynamics, and drug-drug interactions of posaconazole. Literature search was conducted in PubMed. EXPERT OPINION: Posaconazole has a broad antifungal spectrum for both yeasts and molds, with a manageable safety profile. Its efficacy for IFIs is shown in both prophylaxis and salvage treatment. This drug is available as a suspension, tablet, and solution for intravenous administration. The suspension is associated with an erratic absorption, but this is (largely) overcome with the new formulations. Posaconazole is a CYP3A4 inhibitor and substrate for UGT1A4 and P-gp so drug-drug interactions can occur. The exposure in certain subgroups needs to be studied further and the place of routine therapeutic drug monitoring is still to be established.