*Purpose: Lung transplant patients are at an increased risk for invasive fungal infections and often require prophylaxis post-transplant, routinely including posaconazole at our institution. These patients may also have complex post-operative courses and require the use of prolonged enteral feeding tubes, making medication administration challenging. In addition, posaconazole suspension has poor bioavailability and results in lower plasma drug concentrations compared to other formulations, potentially putting patients at an increased risk for fungal infections. Limited proof of concept evidence has been published demonstrating plausibility of achieving detectable concentrations with crushed posaconazole delayed release (DR) tablets via tube. Therefore, our study aims to determine if crushing posaconazole DR tablets results in therapeutic plasma trough concentrations following lung transplant.

*Methods: This was a retrospective study of adult lung transplant recipients who received crushed posaconazole DR tablets through an enteral feeding tube for fungal prophylaxis. Patients were excluded if they received a multi-organ transplant or if they received crushed DR tablets for less than 5 days. Study endpoints included rate of therapeutic concentrations (> 0.7 mcg/ml), number of doses to achieve therapeutic levels, liver function throughout study period, and markers for infection risk (Aspergillus Galactomannan > 0.5).

*Results: A total of 17 lung recipients were evaluated which included 15 bilateral transplants. All patients initially received posaconazole 300 mg per tube once daily. After an average of 8 doses, 58% of patients had detectable posaconazole levels. All patients had concurrent enteral feeding with posaconazole administration. Dose increase to 400mg daily due to subtherapeutic levels occurred in 44% of patients. After dose increase, 43% of these patients had a second level that was therapeutic.

*Conclusions: This study demonstrated that administration of crushed posaconazole DR tablets via enteral feeding tube resulted in therapeutic serum concentrations in 94% of patients. This medication route may be considered in patients unable to swallow whole tablets. Further studies are needed to distinguish interpatient variability and potential drug-drug interactions that affect the pharmacokinetics of crushed posaconazole tablets as well as assess clinical outcomes in a larger sample before universal implementation.

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