NOXAFIL/POSANOL (Posaconazole)

NOXAFIL/POSANOL (Posaconazole)

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What is this medication? 

Posaconazole, Posanol (CDN), Noxafil (US)
Antifungal Agent

Brand Name US: Noxafil
Canadian Equivalent: Posanol

Posaconazole is indicated for treatment of oropharyngeal candidiasis, prophylaxis against invasive fungal infections in malignant or hematopoietic cell transplant patients.

How does this medication work? 

Posaconazole, Posanol, Noxafil is a triazole antifungal that inhibits the ergosterol production by binding and inhibits fungal cytochrome P450 (lanosterol-14α-demethylase) activity, decreasing ergosterol synthesis (principal sterol in fungal cell membrane) and inhibiting fungal cell membrane formation.

How should I take this medication? 

Oral (Delayed Release Tablets): Usual: 300mg 2 times daily for 2 doses, then 300mg once daily.
Oral (Suspension): Usual: 200mg 3 times daily or 400mg twice daily.
Intravenous: Usual: 300mg twice daily for 2 doses, then 300mg once daily.

How to Take:
Oral (Delayed Release Tablets): swallow whole; do not crush, divide, dissolve or chew.  Take with food.
Oral (Suspension): Shake well prior to using and take within 20 minutes following a meal.  Consider an alternative antifungal in patients who are unable to consume a full meal.
Intravenous: Infuse via a central venous line over 90 minutes.  Peripheral line infusion should only be used as a one-time infusion.

You Need to Avoid:  Do not crush, chew, or split the delayed release tablets.  Minimize the use of a peripheral line during IV infusion.  Significant drug interactions exist, requiring dose/frequency adjustment or avoidance so avoid starting any new medications without consulting prescriber.

What should I watch for while using this medication? 

Before starting Posaconazole, Posanol (CDN), Noxafil (US) make sure your physician is aware of any allergies or medications you currently take, if you have renal impairment, arrhythmias, electrolyte abnormalities, are pregnant, or breastfeeding. Posaconazole, Posanol (CDN), Noxafil (US) use has been associated with adverse events such as elevated liver enzymes and does require monitoring of liver function.  Do not take with any CYP3A4 inhibitors or substrates that prolong the QT interval.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C).  Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication? 

Thrombophlebitis, hyper- and/or hypotension, headache, rigors, fatigue, insomnia, chills, dizziness, skin rash, pruritis, electrolyte disturbances, diarrhea, nausea, vomiting, constipation, thrombocytopenia, anemia, neutropenia, petechia, cough, dyspnea, fever, hemorrhage, and infections.

Note: for patients weighing > 120kg monitor for fungal breakthroughs.