The recommended target concentration for treatment is an average steady state concentration of 1.25 mg/L or a steady state trough of 1 mg/L with an 8 h dosing interval. A lower steady state trough concentration of 0.7 mg/L is recommended for prophylaxis (Ashbee, Barnes et al. 2014). The average steady state treatment target comes from an exploratory analysis of the association between exposure metrics and clinical response (Figure 1) (Walsh, Raad et al. 2007).
Figure 1 Exposure response (Walsh, Raad et al. 2007)
Figure 1 Posaconazole oral tablet
There is no effect of diarrhoea (DIA), proton pump inhibitors (PPI) on bioavailability (F).
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Ashbee, H. R., R. A. Barnes, E. M. Johnson, M. D. Richardson, R. Gorton and W. W. Hope (2014). "Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology." J Antimicrob Chemother 69(5): 1162-1176.
Boonsathorn, S., I. Cheng, F. Kloprogge, C. Alonso, C. Lee, B. Doncheva, J. Booth, R. Chiesa, A. Irwin and J. F. Standing (2019). "Clinical Pharmacokinetics and Dose Recommendations for Posaconazole in Infants and Children." Clin Pharmacokinet 58(1): 53-61.
Walsh, T. J., I. Raad, T. F. Patterson, P. Chandrasekar, G. R. Donowitz, R. Graybill, R. E. Greene, R. Hachem, S. Hadley, R. Herbrecht, A. Langston, A. Louie, P. Ribaud, B. H. Segal, D. A. Stevens, J.-A. H. van Burik, C. S. White, G. Corcoran, J. Gogate, G. Krishna, L. Pedicone, C. Hardalo and J. R. Perfect (2007). "Treatment of Invasive Aspergillosis with Posaconazole in Patients Who Are Refractory to or Intolerant of Conventional Therapy: An Externally Controlled Trial." Clinical Infectious Diseases 44(1): 2-12.