Therapeutic Drug Monitoring of Posaconazole in Fungal Infections

Therapeutic drug monitoring (TDM) of posaconazole has become integral to managing invasive fungal infections, particularly in immunocompromised patients. Posaconazole exhibits considerable interpatient variability due to differences in absorption, metabolism and interactions with concomitant medications. Multiple formulations—oral suspension, delayed-release tablets and intravenous infusion—differ in bioavailability and susceptibility to gastrointestinal factors such as diarrhoea or mucositis. TDM aims to maintain plasma concentrations above established pharmacokinetic/pharmacodynamic (PK/PD) targets: commonly 0.5 mg/L for prophylaxis and 1.0 mg/L for treatment of established infections. Monitoring trough levels and area under the concentration–time curve (AUC) guides dose adjustments, minimises toxicity and ensures efficacy across diverse patient groups, including paediatric, transplant and critical-care populations. Emerging evidence highlights the value of measuring unbound drug in hypoalbuminaemic individuals and suggests that high-fat meals, age and sex play lesser roles when using delayed-release formulations. Ultimately, routine TDM fosters global standardisation of posaconazole dosing, reduces breakthrough infections and informs the development of future formulations.

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Therapeutic Drug Monitoring of Posaconazole in Fungal Infections publication trend

The graph below shows the total number of articles in therapeutic drug monitoring of posaconazole in fungal infections across all publications each year (not limited to Nature Index journals).

Technical terms

Therapeutic Drug Monitoring (TDM): systematic measurement of blood drug levels to guide dose adjustments.
Pharmacokinetics (PK): study of the time course of drug absorption, distribution, metabolism and excretion.
Bioavailability: fraction of an administered dose that reaches systemic circulation intact.
Trough concentration (Cmin): lowest drug concentration in plasma before the next dose.
Area under the concentration–time curve (AUC): integral of drug concentration over time, reflecting total exposure.

References

1. Factors affecting posaconazole plasma concentrations: a meta-analysis and systematic review. Frontiers in Pharmacology (2024).
2. Posaconazole exposure in critically ill ICU patients: a need for action. Infection (2023).
3. Utility of posaconazole therapeutic drug monitoring and assessment of plasma concentration threshold for effective prophylaxis of invasive fungal infections: a meta-analysis with trial sequential analysis. BMC Infectious Diseases (2018).
4. Population pharmacokinetics of total and unbound concentrations of intravenous posaconazole in adult critically ill patients. Critical Care (2019).