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Dosing Antifungals in Obesity: a Literature Review

  • Jarrett R. AmsdenEmail author
  • Douglas Slain
Pharmacology and Pharmacodynamics of Antifungal Agents (N Beyda, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pharmacology and Pharmacodynamics of Antifungal Agents

Abstract

Purpose of Review

To summarize the available evidence regarding antifungal dosing in obese adults as well as to provide meaningful guidance on the dosing of each antifungal agent in obese patients.

Recent Findings

The pharmacokinetic evidence regarding dosing antifungal agents in obesity is limited. Fluconazole’s volume of distribution (VD) is influenced by BMI. Therapeutic drug monitoring (TDM) studies provide some insights into dosing voriconazole in obesity, but not with posaconazole. Isavuconazole seems to be unaffected by weight. The available data for echinocandins suggests that increased doses are likely necessary in obese patients. TDM may be beneficial, particularly for azoles when available in a timely manner.

Summary

Fluconazole and voriconazole dosing should be based on total body weight and adjusted body weight, respectively. Posaconazole may have reduced exposures in obese patients, but data on its new dosage forms is lacking. Isavuconazole appears unaffected by weight. Echinocandin doses likely need to be increased in obese patients, but the exact weight and dosages remain elusive.

Keywords

Obesity Antifungals Fluconazole Voriconazole Posaconazole Isavuconazole Caspofungin Micafungin Anidulafungin Echinocandin Triazole antifungal 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of Pharmacy and Health SciencesButler UniversityIndianapolisUSA
  2. 2.Community Health NetworkCommunity North HospitalIndianapolisUSA
  3. 3.Schools of Pharmacy & MedicineWest Virginia UniversityMorgantownUSA

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