Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations

Anne Grete Märtson, Anette Veringa, Edwin R. van den Heuvel, Martijn Bakker, Daan J. Touw, Tjip S. van der Werf, Lambert F.R. Span, Jan Willem C. Alffenaar (Corresponding author)

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Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (<0.7 mg/L for prophylaxis or < 1.5 mg/L for treatment) or high (>3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty-seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1-7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8-2.7) for prophylaxis and 1.76 mg/L (IQR 1.3-2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54%) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64% (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team.

Original languageEnglish
Pages (from-to)698-705
Number of pages8
Issue number8
Early online date30 May 2019
Publication statusPublished - Aug 2019


  • clinical pharmacy
  • haematological malignancies
  • invasive fungal infections
  • longitudinal analysis
  • pharmacist
  • pharmacokinetics
  • posaconazole
  • therapeutic drug monitoring
  • Invasive Fungal Infections/drug therapy
  • Prospective Studies
  • Antimicrobial Stewardship
  • Tablets
  • Administration, Oral
  • Clinical Laboratory Techniques
  • Humans
  • Middle Aged
  • Triazoles/blood
  • Male
  • Dose-Response Relationship, Drug
  • Antifungal Agents/blood
  • Female
  • Aged
  • Drug Monitoring
  • Longitudinal Studies


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