Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium

Pharmacotherapy. 2023 Oct;43(10):1043-1050. doi: 10.1002/phar.2850. Epub 2023 Aug 14.

Abstract

Triazole antifungals (i.e., fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole) are commonly used in clinical practice to prevent or treat invasive fungal infections. Most triazole antifungals require therapeutic drug monitoring (TDM) due to highly variable pharmacokinetics, known drug interactions, and established relationships between exposure and response. On behalf of the Society of Infectious Diseases Pharmacists (SIDP), this insight describes the pharmacokinetic principles and pharmacodynamic targets of commonly used triazole antifungals and provides the rationale for utility of TDM within each agent.

Keywords: fluconazole; isavuconazole; itraconazole; pharmacodynamics; pharmacokinetics; posaconazole; voriconazole.

Publication types

  • Review

MeSH terms

  • Antifungal Agents / pharmacokinetics
  • Antifungal Agents / therapeutic use
  • Communicable Diseases* / drug therapy
  • Drug Monitoring
  • Humans
  • Mycoses* / drug therapy
  • Pharmacists
  • Triazoles / therapeutic use
  • Voriconazole / therapeutic use

Substances

  • Antifungal Agents
  • Triazoles
  • Voriconazole