Table 7.
Dosing regimens (q12h, mg) for heart transplant recipients with CYP3A5 and CYP3A4 genotypes based on BW, hematocrit, and drug combination.
| BW < 50 kg | PM | EM | ||
| Drug combination | Hematocrit | Hematocrit | Hematocrit | Hematocrit |
| (0.2–0.3) | (0.3–0.4) | (0.2–0.3) | (0.3–0.4) | |
| Without voriconazole | 2.5 (92.5) * | 1.8 (90.7) * | 4.0 (94.8) * | 2.8 (96.1) * |
| With voriconazole | 1.0 (91.8) * | 0.5 (92.4) * | 2.0 (90.7) * | 1.0 (94.5) * |
| BW = 50–80 kg | PM | EM | ||
| Drug combination | Hematocrit (0.2–0.3) |
Hematocrit (0.3–0.4) |
Hematocrit (0.2–0.3) |
Hematocrit (0.3–0.4) |
| Without voriconazole | 3.0 (93.8) * | 2.5 (96.3) * | 4.5 (93.3) * | 3.0 (95.7) * |
| With voriconazole | 1.5 (92.9) * | 1.0 (94.1) * | 2.5 (90.5) * | 1.5 (91.9) * |
| BW > 80 kg | PM | EM | ||
| Drug combination | Hematocrit | Hematocrit | Hematocrit | Hematocrit |
| (0.2–0.3) | (0.3–0.4) | (0.2–0.3) | (0.3–0.4) | |
| Without voriconazole | 3.5 (93.2) * | 2.5 (91.8) * | 5.0 (95.3) * | 3.2 (94.2) * |
| With voriconazole | 1.5 (92.5) * | 1.0 (94.4) * | 2.5 (93.7) * | 2.0 (94.0) * |
* Percentage of trough concentrations within target concentrations during therapy; BW: bodyweight; EM: extensive metabolizers (CYP3A5*1*1 or *1*3 and CYP3A4*18B*18B or CYP3A4*1*18B); PM: poor metabolizers (CYP3A5*3*3 and CYP3A4*1*1).