(b) Experience in individuals with pre-existing hepatic disease
| Antifungal | Normal Patients | Mild | Moderate | Severe | Effects on the liver |
|---|---|---|---|---|---|
| (Child-Pugh 5-6) | (Child-Pugh 7–9) | (Child-Pugh >9) | |||
| Anidulafungin | 200 mg loading dose on day 1 followed by 100 mg once/day | 200 mg loading dose on day 1 followed by 100 mg once/day | 200 mg loading dose on day 1 followed by 100 mg once/day | 200 mg loading dose on day 1 followed by 100 mg once/day |
None |
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| Micafungin | 100 mg once/day | 100 mg once/day | 100 mg once/day | Not studied | None |
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| Caspofungin | 70 mg loading dose on day 1 followed by 50 mg once/day | 70 mg loading dose on day 1 followed by 50 mg once/day | 70 mg loading dose on day 1 followed by 35 mg once/day | Not studied | None |
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| Fluconazole | Loading dose of 2x the daily dose, then up to 400 mg daily | No dosage adjustments initially, monitor LFTs in patients for worsening hepatic function | Hepatotoxic | ||
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| Itraconazole | 200 mg q12 IV 100–200 mg q12 po-solution | No studies have been conducted looking at patients with hepatic impairment, use with caution | Hepatotoxic, prolonged elimination half-life in cirrhotic patients (meds metabolized by CYP3A4) | ||
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| Voriconazole | 6 mg/kg IV q12h for the first 24 hours loading dose followed by 3-4 mg/kg IV q12h maintenance dose then 200 mg q12h oral | 6 mg/kg IV q12h for the first 24 hours loading dose followed by 1.5–2 mg/kg IV q12h maintenance dose | 6 mg/kg IV q12h for the first 24 hours loading dose followed by 1.5–2 mg/kg IV q12h maintenance dose | Not studied | Hepatotoxic |
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| Posaconazole | Oral Suspension 200 mg (5 mL) three times a day with a full meal or liquid nutritional supplement, monitoring of LFT's is recommended | Data was not sufficient to determine dosing, should be used with caution | Mild-to-moderate elevation of liver enzymes, bilirubin-generally reversible | ||
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| Amphotericin B deoxycholate | 0.6 to 1 mg/kg/day | Data was not sufficient to determine dosing | Elevation of liver enzymes | ||
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| Ampho B lipid complex (Abelcet) | 5 mg/kg/day | Data was not sufficient to determine dosing | Elevation of liver enzymes | ||
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| Ampho B colloidal dispersion (Amphotec) | 3-4 mg/kg/day can be increased up to 6 mg/kg/day | Data was not sufficient to determine dosing | Elevation of liver enzymes | ||
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| Ampho B liposomal (AmBisome) | 3-4 mg/kg/day can be increased up to 6 mg/kg/day | Data was not sufficient to determine dosing | Elevation of liver enzymes | ||