Isavuconazole therapeutic drug monitoring associated to a pharmacogenetic exploration is far from being a pharmacologist's whim.

Isavuconazole is a new antifungal prodrugto treat invasive aspergillosisand mucormycosis, theoretically not requiring drug monitoring. However, we reported 4 clinical cases with toxic concentrations. Based on Desai9s population pharmacokineticmodel, we estimated patients9 kinetic profile. Clearance was abnormally low, likely related to CYP3A4/5 polymorphisms. Thus, we recommend to collect blood sample just before the first maintenance doseto estimate pharmacokineticprofile and individualized dose. For patients presenting high concentrations, pharmacogeneticscan be done.