Second-generation systemic triazole antifungal
Brand names: Cresemba
Updated · Methodology
First line
Isavuconazole is first-line antifungal for invasive aspergillosis and mucormycosis. 2024 places it on par with voriconazole, preferring isavuconazole in patients at QT risk (methadone, amiodarone) and in renal impairment (the IV formulation is cyclodextrin-free).
ICD-10: B44.0 · ICD-11: 1F20.0
Inhibits fungal 14-alpha-demethylase (CYP51) – blocks ergosterol synthesis. Active against Aspergillus, Mucorales and some rare fungi. Metabolised by CYP3A4 + CYP3A5; itself inhibits CYP3A4 (weaker than voriconazole and posaconazole) but uniquely SHORTENS QT, making it preferred when QT prolongation is a concern.
Limited data. EMA recommends only when necessary.
Breastfeeding not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
4 pairs found. Sorted from critical to minor.
Mechanism
Carbamazepine is a strong CYP3A4 inducer. Isavuconazole falls significantly. Cresemba Section 4.3.
Symptoms
Mycosis progression.
Management
Combination contraindicated.
Sources
Mechanism
Strong CYP3A4 induction.
Symptoms
Mycosis progression.
Management
Combination contraindicated.
Mechanism
Rifampicin is a strong CYP3A4 inducer. Isavuconazole falls 97% – antifungal effect lost.
Symptoms
Fungal infection progression.
Management
Combination contraindicated. Cresemba Section 4.3.
Verbatim lines from the interaction sections, in the language of the label
«Analgésicos; Anestésicos: Isavuconazol»AEMPS, section 4.3 · Open on CIMA
«Established and Other Potentially Significant Drug Interactions: Antifungals : itraconazole, isavuconazole, ketoconazole, posaconazole voriconazole darunavir itraconazole isavuconazole …»FDA, section 7 · Open on DailyMed
«ANTIMICÓTICOS: Fluconazol Isavuconazol Itraconazol Posaconazol Clotrimazol»AEMPS, section 4.5 · Open on CIMA
«Inhibidores de OCT2 (tales como cimetidina, dolutegravir, ranolazina, trimetopreim, vandetanib, isavuconazol) pueden reducir la eliminación renal de metformina y por tanto pueden llevar a un…»AEMPS, section 4.5 · Open on CIMA
«Medicamentos que afectan a la glucuronidación (por ejemplo, isavuconazol, telmisartán)»AEMPS, section 4.5 · Open on CIMA
«Effect of Other Drugs on Mycophenolate Mofetil: Examples Telmisartan (induces glucuronidation); isavuconazole (inhibits glucuronidation).»FDA, section 7 · Open on DailyMed
«Recomendaciones relativas a la a dministración simultánea: Inhibidores del CYP3A4 moderados o débiles: agentes antifúngicos (p. ej., fluconazol, isavuconazol, clotrimazol, miconazol), antibióticos…»AEMPS, section 4.5 · Open on CIMA
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Summary of a multi-drug list →
Medicine list: everything you take in one place →
Isavuconazole is evaluated for the following indications with varying evidence strength: Invasive aspergillosis (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Isavuconazole (≥ 1 in 100): Nausea, vomiting, diarrhoea, Headache, Liver transaminase rise, Hypokalaemia. See the Safety section for uncommon and serious reactions.
Limited data. EMA recommends only when necessary.
Breastfeeding not recommended.
Isavuconazole is contraindicated in: Strong CYP3A4 inducers (rifampicin, phenytoin, carbamazepine); Strong CYP3A4 inhibitors (ketoconazole, high-dose ritonavir); Familial short QT syndrome. Full list in the Safety section.
Amphotericin B, Fluconazole, Itraconazole, Ketoconazole, Posaconazole, Voriconazole