Posaconazole interactions

Food & lifestyle

• cola

  Moderate

  Absorption

  Food significantly increases the absorption of posaconazole from the oral suspension but only modestly from the delayed-release tablet. Following single-dose administration, posaconazole mean peak plasma concentration (Cmax) and systemic exposure (AUC) are approximately 2.5 to 3 times higher when the oral suspension is given with a nonfat meal or a nutritional supplement (14 grams of fat) than when given under fasting conditions, and approximately 3.5 to 4 times higher when given during or 20 minutes after a high-fat meal (50 grams of fat) than under fasting conditions. Acidic beverages may also increase posaconazole absorption.

  What to do: Posaconazole tablets should be taken with food, whereas posaconazole oral suspension should be administered during or immediately (i.e., within 20 minutes) following a full meal to enhance bioavailability. Patients who cannot eat a full meal should take the suspension with a liquid nutritional supplement or an acidic carbonated beverage such as ginger ale. In patients who cannot eat a full meal or tolerate an oral nutritional supplement or an acidic carbonated beverage and who do not have the option of taking another formulation of posaconazole, alternative antifungal therapy should be considered; otherwise, monitor patients closely for breakthrough fungal infections. Patients receiving posaconazole via a nasogastric tube should also be closely monitored due to increased risk of treatment failure associated with lower plasma exposure. Administration of alcohol with posaconazole from the delayed-release oral suspension formulation is not recommended.

  4 sources

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):
  2. Sansone-Parsons A, Krishna G, Calzetta A, et al. "Effect of a nutritional supplement on posaconazole pharmacokinetics following oral administration to healthy volunteers." Antimicrob Agents Chemother 50 (2006): 1881-3
  3. Krishna G, Moton A, Ma L, Malavade D, Medlock M, McLeod J "Effect of gastric pH, dosing regimen and prandial state, food and meal timing relative to dose, and gastro-intestinal motility on absorption and pharmacokinetics of the antifungal posaconazole." 18th European Congress of Clinical Microbiology and Infectious Diseases April (2008): 20
  4. Walravens J, Brouwers J, Spriet I, Tack J, Annaert P, Augustijns P "Effect of pH and Comedication on Gastrointestinal Absorption of Posaconazole: Monitoring of Intraluminal and Plasma Drug Concentrations." Clin Pharmacokinet 50 (2011): 725-34

• high-fat foods

  Moderate

  Absorption

  Food significantly increases the absorption of posaconazole from the oral suspension but only modestly from the delayed-release tablet. Following single-dose administration, posaconazole mean peak plasma concentration (Cmax) and systemic exposure (AUC) are approximately 2.5 to 3 times higher when the oral suspension is given with a nonfat meal or a nutritional supplement (14 grams of fat) than when given under fasting conditions, and approximately 3.5 to 4 times higher when given during or 20 minutes after a high-fat meal (50 grams of fat) than under fasting conditions. Acidic beverages may also increase posaconazole absorption.

  What to do: Posaconazole tablets should be taken with food, whereas posaconazole oral suspension should be administered during or immediately (i.e., within 20 minutes) following a full meal to enhance bioavailability. Patients who cannot eat a full meal should take the suspension with a liquid nutritional supplement or an acidic carbonated beverage such as ginger ale. In patients who cannot eat a full meal or tolerate an oral nutritional supplement or an acidic carbonated beverage and who do not have the option of taking another formulation of posaconazole, alternative antifungal therapy should be considered; otherwise, monitor patients closely for breakthrough fungal infections. Patients receiving posaconazole via a nasogastric tube should also be closely monitored due to increased risk of treatment failure associated with lower plasma exposure. Administration of alcohol with posaconazole from the delayed-release oral suspension formulation is not recommended.

  4 sources

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):
  2. Sansone-Parsons A, Krishna G, Calzetta A, et al. "Effect of a nutritional supplement on posaconazole pharmacokinetics following oral administration to healthy volunteers." Antimicrob Agents Chemother 50 (2006): 1881-3
  3. Krishna G, Moton A, Ma L, Malavade D, Medlock M, McLeod J "Effect of gastric pH, dosing regimen and prandial state, food and meal timing relative to dose, and gastro-intestinal motility on absorption and pharmacokinetics of the antifungal posaconazole." 18th European Congress of Clinical Microbiology and Infectious Diseases April (2008): 20
  4. Walravens J, Brouwers J, Spriet I, Tack J, Annaert P, Augustijns P "Effect of pH and Comedication on Gastrointestinal Absorption of Posaconazole: Monitoring of Intraluminal and Plasma Drug Concentrations." Clin Pharmacokinet 50 (2011): 725-34

Conditions

Conditions in which Posaconazole needs care, as documented in this source.

• Fructose Intolerance

  Major

  Posaconazole powder for delayed-release oral suspension is contraindicated in patients with known/suspected hereditary fructose intolerance (HFI). This formulation contains sorbitol (inactive ingredient) and may precipitate a metabolic crisis that may include (but is not limited to) life-threatening hypoglycemia, hypophosphatemia, lactic acidosis, and hepatic failure in patients with HFI. Careful history of HFI symptoms (nausea, vomiting, abdominal pain) with sorbitol/fructose/sucrose exposure should be obtained before administration of posaconazole powder for delayed-release oral suspension because a diagnosis of HFI may not yet be established in pediatric patients.

  1 source

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):

• Diarrhea

  Moderate

  Patients with severe diarrhea or vomiting should be monitored closely for breakthrough fungal infections when using posaconazole delayed-release tablets, oral suspension, or powder for delayed-release oral suspension.

  1 source

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):

• Kidney Diseases

  Moderate

  Posaconazole injection should be avoided in patients with moderate or severe renal dysfunction (estimated glomerular filtration rate [eGFR] less than 50 mL/min) unless an assessment of the risks and benefits justifies its use. Since the IV vehicle, betadex sulfobutyl ether sodium (SBECD), is expected to accumulate in patients with moderate or severe renal dysfunction using the injection, serum creatinine levels should be closely monitored in these patients, and if increases occur, switching to oral posaconazole therapy should be considered. No dose adjustment is needed for oral dosing in patients with mild to severe renal dysfunction; however, patients with severe renal dysfunction (eGFR less than 20 mL/min/1.73 m2) should be closely monitored for breakthrough fungal infections due to variability in exposure with posaconazole delayed-release tablets, oral suspension, and powder for delayed-release oral suspension.

  1 source

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):

• Liver Diseases

  Moderate

  Posaconazole has been associated with hepatic reactions (e.g., mild to moderate elevations in ALT, AST, alkaline phosphatase, total bilirubin, and/or clinical hepatitis); cases of more severe hepatic reactions (including cholestasis or hepatic failure including deaths) have been reported during therapy in patients with serious underlying medical conditions (e.g., hematologic malignancy), primarily in patients receiving 800 mg/day. Liver tests should be assessed at the start of and during posaconazole therapy; patients with abnormal liver tests during therapy should be monitored for the development of more severe hepatic injury. Patient management should include laboratory evaluation of hepatic function (especially liver tests and bilirubin). Discontinuation of therapy should be considered if clinical signs/symptoms consistent with liver disease develop that may be due to posaconazole.No dose adjustment of posaconazole is necessary in patients with mild to severe liver dysfunction (Child-Pugh A, B, or C). However, posaconazole delayed-release tablets, powder for delayed-release oral suspension, and injection have not been specifically studied; caution is recommended.

  1 source

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):

• Long QT Syndrome

  Moderate

  Some azole antifungals have been associated with prolongation of the QT interval on the ECG. Rare cases of QT prolongation and torsade de pointes have been reported during postmarketing experience; such reports usually involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities, and concomitant medications. These drugs should be administered with caution to patients with potentially proarrhythmic conditions. Concomitant use with other medications that have potential to increase the risk of cardiotoxicity should be avoided.

  7 sources

  1. "Product Information. Nizoral (ketoconazole)." Janssen Pharmaceuticals (2001):
  2. "Product Information. Diflucan (fluconazole)." Roerig Division (2002):
  3. "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals (2002):
  4. "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals (2022):
  5. "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals (2002):
  6. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):
  7. "Product Information. Tolsura (itraconazole)." Mayne Pharma Inc (2021):

• Water-Electrolyte Imbalance

  Moderate

  Electrolyte disturbances (especially those involving potassium, magnesium, or calcium levels) should be monitored and corrected as needed before and during posaconazole therapy.

  1 source

  1. "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation (2006):