{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:43:13Z","timestamp":1789177393991,"version":"build-2803163510"},"reference-count":15,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2016,10,18]],"date-time":"2016-10-18T00:00:00Z","timestamp":1476748800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To describe a case of persistent sub-therapeutic posaconazole levels in setting of salvage chemotherapy for relapsed acute myeloid leukemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case details<\/jats:title>\n                    <jats:p>A 57-year-old male was admitted for the management of relapsed acute myeloid leukemia and ongoing pulmonary aspergillosis. While continuing on posaconazole tablet 300\u2009mg daily, he received a course of salvage chemotherapy. The initial steady state posaconazole trough level was therapeutic at 0.84\u2009mg\/L (target &gt;0.70\u2009mg\/L). However, after five days, the level had dropped to 0.40\u2009mg\/L, coinciding with hyperbilirubinemia and hypoalbuminemia. Bilirubin level peaked at 36\u2009\u00b5m\/L (normal high &lt;20\u2009\u00b5m\/L), albumin levels were consistently low, averaging at 25\u2009g\/L (range 33\u201346\u2009g\/L). The patient had been compliant and there were no underlying gastrointestinal conditions identified which might have potentially affected posaconazole absorption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>An increase in posaconazole dose failed to achieve target levels and treatment was changed to voriconazole. However, levels were surprisingly supra-therapeutic, resulting in side effects and substantial dose reduction was required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Failure to achieve target posaconazole levels despite increased dosing may be attributed to factors other than impaired oral absorption. Enhanced metabolism and clearance could be associated with hypoalbuminemia and hyperbilirubinemia. Further case studies, including PK modelling, are required to confirm this effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1078155216673228","type":"journal-article","created":{"date-parts":[[2016,10,18]],"date-time":"2016-10-18T22:09:09Z","timestamp":1476828549000},"page":"63-66","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Failure to achieve therapeutic levels with high-dose posaconazole tablets potentially due to enhanced clearance"],"prefix":"10.1177","volume":"24","author":[{"given":"Sam","family":"Maleki","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Alfred Hospital, Prahran, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"Corallo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Alfred Hospital, Prahran, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Coutsouvelis","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Alfred Hospital, Prahran, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Alfred Hospital, Prahran, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,10,18]]},"reference":[{"key":"bibr1-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02448-13"},{"key":"bibr2-1078155216673228","doi-asserted-by":"crossref","unstructured":"Nathan P. Wiederhold pharmacokinetics and safety of posaconazole delayed-release tablets for invasive fungal infections.\n                      Clin Pharmacol: Adv Appl\n                      2016; 8: 1\u20138.","DOI":"10.2147\/CPAA.S60933"},{"key":"bibr3-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dks268"},{"key":"bibr4-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00222-12"},{"key":"bibr5-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1533"},{"key":"bibr6-1078155216673228","unstructured":"Posaconazole (Noxafil\u00ae) Product Information. eMIMs, www.mimsonline.com.au (2015)."},{"key":"bibr7-1078155216673228","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1185\/030079907X226230","volume":"23","author":"Krishna G","year":"2007","journal-title":"Curr Med Res Opin"},{"key":"bibr8-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1185\/030079906X167507"},{"key":"bibr9-1078155216673228","doi-asserted-by":"crossref","unstructured":"Lindsay J, Ibrahim K and Sandaradura I. Posaconazole plasma concentrations during intravenous to oral tablet crossover: are variations due to distribution and metabolism rather than absorption.\n                      Biol Blood Marrow Transplant\n                      22: S475\u2013S476.","DOI":"10.1016\/j.bbmt.2015.11.1090"},{"key":"bibr10-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e328359a56e"},{"key":"bibr11-1078155216673228","doi-asserted-by":"crossref","unstructured":"Chau M, Kong D, van Hal J, et\u00a0al. Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy, 2014.\n                      Intern Med J\n                      2014; 44: 1364\u20131388.","DOI":"10.1111\/imj.12600"},{"key":"bibr12-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2010.64"},{"key":"bibr13-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-198002040-00005"},{"key":"bibr14-1078155216673228","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-08-046884-6.00420-6"},{"key":"bibr15-1078155216673228","volume-title":"Handbook of drug metabolism","author":"Remmel RP","year":"2009","edition":"2"}],"container-title":["Journal of Oncology Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1078155216673228","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1078155216673228","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1078155216673228","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:16:59Z","timestamp":1777688219000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1078155216673228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,18]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1177\/1078155216673228"],"URL":"https:\/\/doi.org\/10.1177\/1078155216673228","relation":{},"ISSN":["1078-1552","1477-092X"],"issn-type":[{"value":"1078-1552","type":"print"},{"value":"1477-092X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,18]]}}}