Posaconazole liquid suspension in solid organ transplant recipients previously treated with voriconazole

Background Posaconazole ( PCZ ) has become an attractive alternative to voriconazole ( VCZ ) in transplant recipients with suspected or proven invasive filamentous fungal infections, causing fewer drug interactions. Here, we describe our experience with PCZ after VCZ in solid organ transplant ( SOT ) recipients. Methods VCZ was replaced by PCZ liquid solution in 19 SOT recipients (15 lung, 2 kidney, 1 liver, and 1 heart/lung) with invasive pulmonary aspergillosis (12/19; 63.2%), possible invasive pulmonary fungal infection (2/19; 10.5%), prophylaxis (2/19; 10.5%), or pulmonary scedosporiosis, mucormycosis, and mixed fungal species (1 each). Rationales for switch were suspected adverse reactions to VCZ (17/19; 89.4%) and desire to broaden spectrum of coverage to include agents of mucormycosis (3/19; 15.8%). Results PCZ was well tolerated in all patients. In those patients with baseline liver enzyme abnormalities, a median change occurred in concentrations of alanine transaminase (−20 IU/L), aspartate aminotransferase (−17.5 IU/L), and alkaline phosphatase (−61.5 IU/L). Clinical success (resolution, stabilization, or prevention of infection) was achieved in 16/19 (84%) people. Conclusion PCZ appears to have a reasonable safety and tolerability profile and may be an effective alternative in SOT patients who require an agent with anti‐mold activity, but are unable to tolerate VCZ .