Home Drug Guide Isavuconazonium Sulfate

Drug Guide

Generic Name

Isavuconazonium Sulfate

Brand Names Cresemba

Classification

Therapeutic: Antifungal

Pharmacological: Azole antifungal

FDA Approved Indications

  • Invasive aspergillosis in immunocompromised patients
  • Mucormycosis (zygomycosis)

Mechanism of Action

Inhibits the synthesis of ergosterol, a vital component of fungal cell membranes, by selectively inhibiting the enzyme lanosterol 14α-demethylase, leading to increased cell membrane permeability and cell death.

Dosage and Administration

Adult: Initial loading dose of 372 mg (equivalent to 200 mg of isavuconazole) every 8 hours for 6 doses, followed by maintenance dose of 372 mg once daily.

Pediatric: Safety and efficacy not established in pediatric patients.

Geriatric: No specific dosage adjustments; use with caution and monitor closely.

Renal Impairment: No dose adjustment recommended for mild to moderate impairment; use caution in severe impairment.

Hepatic Impairment: Dose adjustment may be necessary; consult specific guidelines.

Pharmacokinetics

Absorption: Oral bioavailability approximately 98%.

Distribution: Widely distributed; volume of distribution roughly 450 liters.

Metabolism: Metabolized by hydrolysis and cytochrome P450 enzymes.

Excretion: Excreted mainly in feces; minimal urinary excretion.

Half Life: Approximately 130 hours (about 5.5 days).

Contraindications

  • Hypersensitivity to isavuconazole or other azoles.

Precautions

  • Monitor liver function due to potential hepatotoxicity.
  • Use with caution in patients with hepatic impairment.
  • Potential drug interactions; review concomitant medications.

Adverse Reactions - Common

  • Junndice, elevated liver enzymes (Less common)
  • Headache (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • Hepatotoxicity leading to liver failure (Rare)
  • Infusion reactions including edema, hypokalemia, hypomagnesemia (Rare)
  • QT interval prolongation or shortening (Possible, monitor ECG)

Drug-Drug Interactions

  • CYP3A4 inducers or inhibitors (e.g., rifampin, ketoconazole, clarithromycin)

Drug-Food Interactions

  • None specific.

Drug-Herb Interactions

  • St. John’s Wort and other herbal products affecting CYP pathways.

Nursing Implications

Assessment: Monitor liver function tests (ALT, AST, bilirubin), renal function, electrolytes, and ECG for QT interval changes.

Diagnoses:

  • Risk for impaired liver function
  • Electrolyte imbalance
  • Potential drug interactions

Implementation: Administer as directed, monitor labs and vital signs, and educate patients about potential side effects.

Evaluation: Assess for resolution of infection, monitor for adverse effects, and adjust therapy based on response and labs.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of liver problems such as jaundice or unusual fatigue.
  • Avoid alcohol and hepatotoxic substances.
  • Inform healthcare providers of all medications and OTC products.

Special Considerations

Black Box Warnings:

  • Hepatotoxicity: serious liver injury has been reported.
  • QT interval prolongation or shortening: monitor ECG, especially in patients with cardiac history.

Genetic Factors: None specifically associated.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Nausea, vomiting, liver enzyme elevations, QT changes.

Treatment: Supportive care, monitor cardiac status, and liver function; no specific antidote.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable until expiration date printed on the packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.