Agent | Dose | Recommendation | Potential Adverse Events | Potential Drug Interactions | Additional Considerations | Monitoring |
---|---|---|---|---|---|---|
Voriconazole | Induction: 6 mg/kg IVa every 12 h the first day Maintenance: 4 mg/kg IVa, 200-300 mg PO twice daily | 1st line [14] | -Hepatotoxicityb -Visual changes -Neurologic toxicity -Rash and photosensitivity -Periostitis -QTc prolongationc | -Sirolimusd -Tacrolimusd -Cyclosporined | -Non-linear pharmacokinetics -Strong inhibitor of CYP3A4 -Moderate inhibitor of CYP2C19 and 2C9 -Metabolized via CYP2C19, 2C9 and 3A4 - < 2% of voriconazole is excreted in the urine | -Liver function tests −12-lead ECGf -Voriconazole TDMd -Sirolimus, tacrolimus, and cyclosporine TDMd |
Isavuconazole | Induction: 200 mg three times daily the first 2 days Maintenance: 200 mg daily | 1st line [15] Primary alternative [14] | -Hepatotoxicityb | -Sirolimuse -Tacrolimuse -Cyclosporinee | -Linear pharmacokinetics -Moderate inhibitor of CYP3A4 -Metabolized via CYP3A4 -Isavuconazole may cause QTc shortening | -Liver function tests -Sirolimus, tacrolimus, and cyclosporine TDMe |
Liposomal Amphotericin B | 3–5 mg/kg daily IV | - Nephrotoxicityg |  |  | -Renal function and electrolytes |