### Dosing CrCl > 80: 200 mg tid. Only comes po. CrCl 80-50: CrCl 50-10: CrCl < 10: Hemodialysis: Peritoneal dialysis:> "Posaconazole-induced hypertension and hypokalemia due to inhibition of the 11 β-hydroxylase enzyme." [^1] > "Posaconazole is associated with secondary hypertension and hypokalemia, consistent with pseudohyperaldosteronism, and development is associated with higher serum [[Posaconazole]] concentrations, older age, and baseline hypertension." [^2] ### Important drug interactions These drugs interact with damn near everything else so check with your pharmacist or this reference at CID. [^3] ### Rants and Screeds ### Pearls Low serum levels are associated with breakthrough fungal infections. [^4] And high levels are associated with toxicity. [^5] So, if you can, get a drug level in patients on the drug long term. ### Treatment of choice *Zygomyces*. ### Use for *[[Aspergillus]]* *fumigatus*, *[[Candida]]*, *[[Cryptococcus]]* *neoformans*, *[[Fusarium]]*, Phaeohyphomycosis, and *Zygomyces*. Fungal prophylaxis in graft vs. host disease. ### Important side effects > "Posaconazole-induced hypertension and hypokalemia due to inhibition of the 11β-hydroxylase enzyme." [^1] > "Posaconazole is associated with secondary hypertension and hypokalemia, consistent with pseudohyperaldosteronism, and development is associated with higher serum [[Posaconazole]] concentrations, older age, and baseline hypertension." [^2] ### Important drug interactions These drugs interact with damn near everything else so check with your pharmacist or this reference at CID. [^3] ### Rants and Screeds ### Pearls Low serum levels are associated with breakthrough fungal infections. [^4] And high levels are associated with toxicity. [^5] So, if you can, get a drug level in patients on the drug long term. ### Treatment of choice *Zygomyces*. ### Use for *[[Aspergillus]]* *fumigatus*, *[[Candida]]*, *[[Cryptococcus]]* *neoformans*, *[[Fusarium]]*, Phaeohyphomycosis, and *Zygomyces*. Fungal prophylaxis in graft vs host disease. ### Don't use for ### Class Triazole. ### Rationalizations [^1]: Barton K, Davis TK, Marshall B, Elward A, White NH. Posaconazole-induced hypertension and hypokalemia due to inhibition of the 11β-hydroxylase enzyme. Clin Kidney J. 2018 Oct;11(5):691-693. doi: 10.1093/ckj/sfx156. Epub 2018 Jan 30. PMID: 30289132; PMCID: PMC6165748. [^2]: Minh-Vu H Nguyen, Matthew R Davis, Rebecca Wittenberg, Ian Mchardy, John W Baddley, Brian Y Young, Alex Odermatt, George R Thompson, Posaconazole Serum Drug Levels Associated With Pseudohyperaldosteronism, _Clinical Infectious Diseases_, Volume 70, Issue 12, 15 June 2020, Pages 2593–2598, [https://doi.org/10.1093/cid/ciz741](https://doi.org/10.1093/cid/ciz741) [^3]: Roger J. M. Brüggemann, Jan-Willem C. Alffenaar, Nicole M. A. Blijlevens, Eliane M. Billaud, Jos G. W. Kosterink, Paul E. Verweij, David M. Burger, Louis D. Saravolatz, Clinical Relevance of the Pharmacokinetic Interactions of Azole Antifungal Drugs with Other Coadministered Agents, Clinical Infectious Diseases, Volume 48, Issue 10, 15 May 2009, Pages 1441–1458, https://doi.org/10.1086/598327 [^4]: Lerolle N, Raffoux E, Socie G, Touratier S, Sauvageon H, Porcher R, Bretagne S, Bergeron A, Azoulay E, Molina JM, Lafaurie M. Breakthrough invasive fungal disease in patients receiving [[Posaconazole]] primary prophylaxis: a 4-year study. Clin Microbiol Infect. 2014 Nov;20(11):O952-9. doi: 10.1111/1469-0691.12688. Epub 2014 Jul 12. PMID: 24861577. [^5]: Tverdek FP, Heo ST, Aitken SL, Granwehr B, Kontoyiannis DP. Real-Life Assessment of the Safety and Effectiveness of the New Tablet and Intravenous Formulations of Posaconazole in the Prophylaxis of Invasive Fungal Infections via Analysis of 343 Courses. Antimicrob Agents Chemother. 2017 Jul 25;61(8):e00188-17. doi: 10.1128/AAC.00188-17. PMID: 28507111; PMCID: PMC5527592.