What is the recommended dosage of Posaconazole (posaconazole) for adults and pediatric patients?

Posaconazole Dosage Recommendations for Adults and Pediatric Patients

The recommended dosage of posaconazole varies by formulation, age group, and indication, with delayed-release tablets requiring 300 mg twice daily on day 1 followed by 300 mg once daily for adults and adolescents ≥13 years, while oral suspension requires 200 mg four times daily or 400 mg twice daily for most indications. 1, 2

Adult Dosing Recommendations

Delayed-Release Tablets

• Loading dose: 300 mg (three 100 mg tablets) twice daily on day 1
• Maintenance dose: 300 mg once daily starting on day 2 1
• Tablets should be swallowed whole (not divided, crushed, or chewed)
• Can be administered with or without food 1

Intravenous (IV) Formulation

• Loading dose: 300 mg twice daily on day 1
• Maintenance dose: 300 mg once daily from day 2 2
• For treatment of invasive aspergillosis in critically ill patients, an optimized regimen of 400 mg daily maintenance may be needed to achieve therapeutic targets 3

Oral Suspension

• Standard dosing: 200 mg (5 mL) four times daily or 400 mg (10 mL) twice daily after stabilization 2
• Must be taken with a full meal or liquid nutritional supplement to ensure adequate absorption 2
• Important: Oral suspension is NOT interchangeable with delayed-release tablets due to differences in bioavailability 1

Pediatric Dosing Recommendations

Adolescents (13-17 years)

• Delayed-release tablets: Same as adult dosing - 300 mg twice daily on day 1, then 300 mg once daily 1, 2

Children (<13 years)

• Limited FDA-approved options for this age group
• Posaconazole is not FDA-approved for children under 13 years of age 1

Indication-Specific Dosing

Prophylaxis of Invasive Fungal Infections

• Delayed-release tablets: 300 mg twice daily on day 1, then 300 mg once daily 1
• Oral suspension: 200 mg three times daily 4
• Duration based on recovery from neutropenia or immunosuppression 1

Treatment of Mucormycosis

• Oral suspension: 400 mg twice daily after stabilization of disease 2
• Delayed-release tablets: 300 mg twice daily on day 1, then 300 mg once daily from day 2 2
• IV formulation: 300 mg twice daily on day 1, then 300 mg once daily from day 2 2

Special Considerations

Therapeutic Drug Monitoring

• Recommended for oral suspension due to variable absorption 2
• Target trough concentration:
  • For prophylaxis: ≥0.7 mg/L 2
  • For treatment: ≥1.0 mg/L 3

Formulation Selection

• Delayed-release tablets provide higher and more consistent plasma concentrations than oral suspension 5
• For patients who cannot eat a full meal, delayed-release tablets should be preferred over oral suspension 1

Renal Impairment

• No dosage adjustment necessary for patients with renal impairment 1

Practical Application Algorithm

1. Determine patient age:

   • ≥13 years: Can use delayed-release tablets or oral suspension
   • <13 years: Limited FDA-approved options

2. Assess ability to take oral medications:

   • If unable to take oral medications: Use IV formulation
   • If able to take oral medications: Proceed to next step

3. Evaluate ability to consume food:

   • If unable to consume full meals: Use delayed-release tablets
   • If able to consume full meals: Either formulation acceptable

4. Select formulation based on indication:

   • For prophylaxis: Delayed-release tablets preferred when possible
   • For treatment of established infection: Consider higher dosing regimens

5. Monitor therapy:

   • Perform therapeutic drug monitoring, especially with oral suspension
   • Assess for drug interactions, particularly with sirolimus, cyclosporine, tacrolimus, and CYP3A4 substrates 1

Remember that posaconazole formulations are not interchangeable, and dosing must be specific to the formulation being used to ensure therapeutic success and minimize toxicity.