Isavuconazonium Sulfate Capsules (Cresemba) is a triazole antifungal medication, primarily used to treat invasive aspergillosis and mucormycosis. Its active ingredient is isavuconazole, which exerts antifungal effects by inhibiting the synthesis of ergosterol in fungal cell membranes.

How to Use Isavuconazonium Sulfate Capsules (Cresemba)

Administration Route and Treatment Course

Oral Administration: Capsules must be swallowed whole; do not chew, crush, or open them. They can be taken with food or on an empty stomach, as food does not affect bioavailability.

Intravenous to Oral Switch: If intravenous formulation (isavuconazonium sulfate injection) is initially used, it can be seamlessly switched to oral capsules once the patient’s condition is stable, with no need for reloading dose.

Treatment Course: The duration of treatment should be adjusted individually based on the severity of infection and patient response. It usually continues until clinical symptoms resolve and imaging/microbiological evidence confirms the clearance of infection.

Standard Regimen for Adults

Loading Dose: 372mg (equivalent to 200mg isavuconazole) orally every 8 hours within the first 48 hours, totaling 6 doses.

Maintenance Dose: Starting 12-24 hours after the end of the loading dose, 372mg orally once daily.

Pediatric Patients (≥ 6 years old and body weight ≥ 16kg)

Doses are adjusted based on body weight. For example, pediatric patients with a body weight of 16-18kg need to take 2 capsules of 74.5mg (149mg in total) orally every 8 hours, and the subsequent maintenance dose is the same dose taken once daily.

Dosage Adjustment of Isavuconazonium Sulfate Capsules (Cresemba)

Patients with Hepatic or Renal Impairment

Mild to Moderate Hepatic Impairment (Child-Pugh Class A/B): No dosage adjustment is required, but liver function should be closely monitored.

Severe Hepatic Impairment (Child-Pugh Class C): Use only when the benefit outweighs the risk, and enhance clinical monitoring.

Renal Impairment (including end-stage renal disease): No dosage adjustment is needed, and hemodialysis does not affect drug clearance.

Adjustments Due to Drug Interactions

Contraindicated Concomitant Drugs: Strong CYP3A4 inhibitors (e.g., ketoconazole, high-dose ritonavir) or inducers (e.g., rifampicin, carbamazepine), which may significantly alter the blood concentration of isavuconazole.

Concomitant Drugs Requiring Monitoring: Immunosuppressants (cyclosporine, sirolimus, tacrolimus): When used together, monitor blood concentrations and adjust doses accordingly.

P-glycoprotein Substrates (e.g., digoxin): Dose reduction may be necessary to avoid toxicity.

Use of Isavuconazonium Sulfate Capsules (Cresemba) in Special Populations

Pediatric Patients

≥ 1 year old and body weight ≥ 16kg: Intravenous formulation can be used; pediatric patients ≥ 6 years old with 达标 body weight can choose oral capsules.

Dose Calculation: Stratified by age and body weight. For example, pediatric patients aged 1-3 years need intravenous administration at 15mg/kg, with the same maintenance dose.

Pregnant and Lactating Women

Pregnancy: Animal studies have shown embryotoxicity. Pregnant women should use it only when the potential benefit outweighs the risk, and the potential risk to the fetus should be informed.

Lactation: Isavuconazole may be excreted in breast milk; it is recommended to suspend breastfeeding during treatment.