Drug Action
Isavuconazole is a triazole antifungal that blocks the synthesis of ergosterol, a key component of the fungal cell membrane.
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Drug reference
Isavuconazole is a triazole antifungal that blocks the synthesis of ergosterol, a key component of the fungal cell membrane.
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Invasive aspergillosis | Mucormycosis in patients for whom amphotericin B is inappropriate ▶BY MOUTH, OR BY INTRAVENOUS INFUSION ▶Adult: Loading dose 200 mg every 8 hours for 48 hours (6 administrations in total), then maintenance 200 mg once daily, maintenance dose to be started at least 12 hours after the last loading dose; long-term treatment should be reviewed after 6-months
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Acute porphyrias p. 1120. short QT syndrome
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Elderly—limited information
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All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 2433 The All Wales Medicines Strategy Group has advised (January 2017) that isavuconazole (Cresemba ®) is recommended as an option for use in adults within NHS Wales for the treatment of invasive aspergillosis, and the treatment of mucormycosis in patients for whom amphotericin B is inappropriate, only if the approved Wales Patient Access Scheme (WPAS) is used or where the list/contract price is equivalent or lower.
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→Appendix 1: antifungals, azoles
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GENERAL SIDE-EFFECTS ▶Common or very common Appetite decreased. asthenia. chest pain. delirium. diarrhoea. drowsiness. electrolyte imbalance. gastrointestinal discomfort. headache. hepatic disorders. nausea. skin reactions. thrombophlebitis ▶Uncommon Alopecia. anaemia. arrhythmias. back pain. circulatory collapse. confusion. constipation. depression. dizziness. dyspnoea. encephalopathy. haemorrhage. hypersensitivity. hypoalbuminaemia. hypoglycaemia. hypotension. insomnia. leucopenia. malaise. malnutrition. neutropenia. palpitations. pancytopenia. paraesthesia. peripheral neuropathy. renal failure. respiratory disorders. seizures. syncope. taste altered. thrombocytopenia. vertigo. vomiting SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With intravenous use Hyperbilirubinaemia ▶Uncommon ▶With intravenous use Peripheral oedema SIDE-EFFECTS, FURTHER INFORMATION Infusion-related reactions have been reported, including hypotension, dyspnoea, dizziness, paraesthesia, nausea, and headache— manufacturer advises discontinue treatment if these reactions occur.
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Manufacturer advises avoid unless severe or life-threatening infection—toxicity in animal studies.
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Manufacturer advises avoid—present in Infection milk in animal studies.
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Manufacturer advises caution in severe impairment (no information available)—monitor for drug toxicity.
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▶With intravenous use For intravenous infusion, reconstitute each 200 mg with 5 mL Water for Injection; dilute dose to concentration of 0.8 mg/mL with Glucose 5% or Sodium Chloride 0.9% and give via a 0.2–1.2 micron filter over at least 1 hour. l HANDLING AND STORAGE ▶With intravenous use Manufacturer advises store in a refrigerator (2–8°C)—consult product literature for storage after reconstitution or dilution.
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There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion CAUTIONARY AND ADVISORY LABELS 3 ▶Cresemba (Pfizer Ltd) A Isavuconazole (as Isavuconazonium sulfate) 200 mg Cresemba 200mg powder for concentrate for solution for infusion vials | 1 vial P £297.84 (Hospital only) Capsule CAUTIONARY AND ADVISORY LABELS 3, 25 ▶Cresemba (Pfizer Ltd) A Isavuconazole (as Isavuconazonium sulfate) 100 mg Cresemba 100mg capsules | 14 capsule P £599.28 (Hospital only)
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Driving and skilled tasks Manufacturer advises patients and carers should be cautioned on the effects on driving and performance of skilled tasks—increased risk of confusion, syncope and dizziness.
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Loading dose 200 mg every 8 hours for 48 hours
First-line fragment. Read the complete Indications and Dose section above.
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