Clinical pharmacology and therapeutic considerations of isavuconazole in special populations: a narrative review.

Isavuconazole, a broad-spectrum triazole antifungal, is an important option for invasive mould infections. This narrative review summarizes current evidence regarding its clinical pharmacology and therapeutic use in pediatric and geriatric patients, pregnant or lactating women, and patients with renal or hepatic impairment, and reviews selected disease-specific settings including hematologic malignancies, solid organ transplantation, advanced HIV infection, and severe respiratory viral infections complicated by invasive fungal disease. Potential advantages include fewer neurovisual adverse effects than voriconazole, intravenous use without cyclodextrin-associated renal concerns, and a favorable cardiac profile in patients at risk of QT prolongation. Important uncertainties remain regarding dosing in younger children, severe hepatic impairment, pregnancy, antifungal prophylaxis, and therapeutic drug monitoring (TDM). Routine TDM is not supported by a validated universal exposure target; however, selective TDM can be clinically useful when pharmacokinetics are likely to be altered or when toxicity, treatment failure, nonstandard administration, extracorporeal support, or major drug-drug interactions are concerns. This review emphasizes individualized, evidence-informed use and identifies priorities for population specific research.