Isavuconazonium Sulfate Capsules (Cresemba) is a triazole antifungal drug primarily indicated for the treatment of invasive aspergillosis and mucormycosis.
How to Use Isavuconazonium Sulfate Capsules (Cresemba)
Route of Administration
Isavuconazonium sulfate can be administered in two ways: oral capsules or intravenous injection.
The two dosage forms are interchangeable, and no reloading dose is required during the conversion.
Oral capsules should be swallowed whole; chewing, crushing, dissolving, or opening the capsules is not allowed.
Administration Time
Capsules can be taken with food or on an empty stomach, as this does not affect absorption.
Intravenous formulations must be administered via an infusion set equipped with an in-line filter (with a pore size of 0.2 to 1.2 micrometers), and each infusion should take at least 1 hour.
Course of Treatment
The standard treatment regimen includes a 48-hour loading dose phase followed by a maintenance treatment phase.
The duration of treatment should be determined based on the patient's clinical response and mycological assessment results, and usually continues for a period after the improvement of clinical symptoms and imaging findings.
Dose Adjustment of Isavuconazonium Sulfate Capsules (Cresemba)
Standard Dosage Regimen
Loading dose: 372 mg of isavuconazonium sulfate (equivalent to 200 mg of isavuconazole) every 8 hours for a total of 6 doses (over 48 hours). For oral administration, take 2 capsules each time; for intravenous administration, use 1 reconstituted injection each time.
Maintenance dose: Start 12-24 hours after the end of the loading dose, administer 372 mg of isavuconazonium sulfate (equivalent to 200 mg of isavuconazole) once daily. For oral administration, take 2 capsules daily; for intravenous administration, use 1 reconstituted injection daily.
Dose Adjustment for Patients with Hepatic Impairment
Patients with mild to moderate hepatic impairment (Child-Pugh Class A and B) do not require dose adjustment.
Patients with severe hepatic impairment (Child-Pugh Class C) should only use the drug if the expected benefit outweighs the risk, and close monitoring for drug-related adverse reactions is necessary.
Dose Adjustment for Patients with Renal Impairment
Patients with renal impairment of all degrees, including those with end-stage renal disease, do not require dose adjustment.
Hemodialysis does not affect drug clearance, and no supplementary dose is needed after dialysis.
Medication for Special Populations of Isavuconazonium Sulfate Capsules (Cresemba)
Pregnant Women
Use during pregnancy may cause harm to the fetus.
The drug should only be considered if the expected benefit to the mother outweighs the potential risk to the fetus.
Patients who become pregnant during treatment should inform their doctor immediately.
Elderly Patients
The pharmacokinetic characteristics of elderly patients (≥65 years old) are similar to those of young patients, so no dose adjustment is required.
However, close monitoring for potential increased drug-related adverse reactions is necessary during clinical use.
