Comparison of clinical pharmacology of voriconazole and posaconazole

Abstract

Despite greater knowledge and possibilities in pharmacotherapy, fungal infections remain a challenge for clinicians. As the population of immunocompromised patients and those treated for their hematologic ailments increases, the number of fungal infections grows too. This is why there is still a quest for new antifungal drugs as well as for optimization of pharmacotherapy with already registered pharmaceutics.Voriconazole and posaconazole are broad-spectrum, new generation, triazole antifungal agents. The drugs are used in the pharmacotherapy of invasive aspergillosis, Candida and Fusarium infections. Voriconazole is also used in infections caused by Scedosporium. Posaconazole is used in the treatment of coccidioidomycosis and chromoblastomycosis. Besides some similarities, the two mentioned drugs also show differences in therapeutic indications, pharmacokinetics (mainly absorption and metabolism), frequency and severity of adverse drug reactions, drug–drug interactions and dosage. As both of the drugs are used in the treatment of invasive fungal infections in adults and children, detailed knowledge of the clinical pharmacology of antifungal agents is the main factor in pharmacotherapy optimization in treatment of fungal infections.The goal of the article is to present and compare the clinical pharmacology of voriconazole and posaconazole as well as to point out the indications and contraindications of using the drugs, determine factors influencing their pharmacotherapy, and provide information that might be helpful in the treatment of fungal infections.

Epidemiological Characterization of Clinical Fungal Isolates from Pauls Stradinš Clinical University Hospital, Latvia: A 4-Year Surveillance Report

“…The newer generation of azoles, such as voriconazole and posaconazole, have been developed and approved for clinical use. These are broad-spectrum antifungal agents which inhibit fungal cytochrome P450-mediated 14-alpha lanosterol demethylation, causing structural damage and a loss of cell membrane function [ 113 ]. Both are recommended as first-line prophylaxis against invasive Candida and Aspergillus infections, while the are second-in-line for treating fusariosis (in the case of intolerance to amphotericin B) [ 113 ].…”

Use of Antifungals Other Than Amphotericin B for Invasive Fungal Infections in Neonates and Children

“…ADRs that occur more often during treatment with voriconazole than posaconazole are sinusitis, hypoglycemia, hypokalemia, depression, hallucinations, anxiety, headache and dizziness, peripheral edema, thrombophlebitis, hypotension, acute respiratory distress syndrome, pulmonary edema, jaundice, backache, acute renal failure, and hematuria. 25 In general, posaconazole has a very good safety and tolerability profile. 26 In clinical trials, posaconazole was also particularly well tolerated.…”

Therapeutic Drug Monitoring in Fungal Infections: the Dawn of Proactive Monitoring

“…The steady-state volume of distribution of voriconazole is estimated to be 4.6 L/kg, and the cerebrospinal fluid concentrations reach 50% of serum concentrations. Plasma protein binding is estimated to be 58% [24,25].…”