Noxafil vs. Ambisome for Fungal Infection: Important Differences and Potential Risks.

Key takeaways

Posaconazole (Noxafil) and amphotericin B liposome (Ambisome) are both antifungal medications used to treat serious fungal infections. They are similar in that they both target infections caused by Aspergillus and Candida. However, posaconazole is also used to prevent serious fungal infections in people with weakened immune systems, while amphotericin B liposome is used to treat Cryptococcal meningitis and other serious fungal infections. Posaconazole is an azole antifungal available as an oral suspension, tablets, and an intravenous infusion. Amphotericin B liposome is given as an intravenous infusion, usually over 1 to 2 hours, and is not available in an oral form. Common side effects of posaconazole include diarrhea and nausea, while amphotericin B liposome can cause chills, nausea, and changes in kidney and liver tests. Posaconazole has many drug interactions, while amphotericin B liposome can cause kidney damage, especially if you have a history of kidney problems.

Posaconazole

(Noxafil)

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Ambisome

(amphotericin B liposome)

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Summary for Noxafil

Prescription only

Posaconazole (Noxafil) infusion is an azole antifungal injection. It's used to treat serious Aspergillus fungal infections in adults and children ages 2 years and older. It's also used to prevent Candida and Aspergillus infections in adults and children ages 2 years and older with weakened immune systems. Posaconazole (Noxafil) infusion is given as an infusion into the veins, typically twice a day on the first day and then once a day thereafter. Common side effects include diarrhea, nausea, and abnormal liver tests.

Indications for Noxafil

Prevention of serious fungal infections caused by Candida and Aspergillus
Treatment of serious Aspergillus infection

Pros and Cons for Noxafil

Pros

Can be used in adults and children
Once-daily dosing after the first day
A good option for people who can't take medications by mouth

Cons

Many interactions with other medications
Might not be a good option for people with moderate or severe kidney problems
Might not be safe during pregnancy

Common Side Effects for Noxafil

Diarrhea (32%)
Low potassium levels (22%)
Fever (21%)
Nausea (19%)
Rash (15%)
Nose bleed (14%)
Headache (14%)
Stomach pain (13%)
Vomiting (12%)
Chills (12%)
Swelling in arms or legs (12%)

Note: The side effects listed above were reported by adults taking posaconazole (Noxafil) infusion for prevention of fungal infections.

Warnings for Noxafil

QT prolongation (heart rhythm problem)
Changes in electrolytes
Liver damage
Interaction with transplant medications
Interaction with midazolam
Interaction with vincristine
Interaction with venetoclax

Summary for Ambisome

Prescription only

Ambisome (amphotericin B liposome) is effective at treating many severe and deadly fungal infections, but it has many side effects.

Indications for Ambisome

Fungal infections in people with a fever and a low number of white blood cells
Cryptococcal meningitis in people with HIV
People with severe fungal infections caused by Aspergillus, Candida, or Cryptococcus who have already tried other antifungals or cannot take other antifungals
Black fever (visceral leishmaniasis)

Pros and Cons for Ambisome

Pros

Treats life-threatening infections
Works when other antifungals fail
Not as hard on your kidneys as Abelcet (amphotericin B lipid complex)
Has been used safely in children as young as 1 year old

Cons

Must be given through an IV line over 1 to 2 hours
Must be given in a hospital or by a trained home healthcare professional
Can be given for several weeks for more severe infections
Many side effects
Blood tests required

Common Side Effects for Ambisome

Chance of experiencing side effects from Ambisome (amphotericin B liposome) varies depending on the dose that's being given.

Chills (40-48%)
Low potassium (38-43%)
Nausea (26-40%)
Rash (24-25%)
Vomiting (22-32%)
Diarrhea (15-30%)
Trouble breathing (18-23%)
Changes to liver blood tests (7-22%)
Changes to kidney blood tests (20-22%)
Stomach pain (13-20%)
Fever, chills, hives, and itching while Ambisome (amphotericin B liposome) is being infused or shortly after (11-19%)
Swelling (13-14%)