posaconazole
Oral posaconazole (Noxafil) is an azole antifungal. It's taken by mouth to prevent and treat serious Aspergillus and Candida fungal infections in adults and children. Posaconazole (Noxafil) is available as an oral suspension and tablet (both brand name and generic), as well as powder for oral suspension (brand only). Posaconazole (Noxafil) is also available as an intravenous infusion that's typically given in a hospital setting by a healthcare professional. The dosing depends on what condition you're taking it to treat, your age, and which formulation you're taking. Potential side effects include diarrhea, nausea, and abnormal liver tests.
What is Posaconazole (Noxafil)?
What is Posaconazole (Noxafil) used for?
- Prevention of serious fungal infections caused by Candida and Aspergillus
- Treatment of serious Aspergillus infection - tablets only
- Treatment of oral thrush of the mouth and throat - liquid suspension only
How Posaconazole (Noxafil) works
Posaconazole (Noxafil) is an azole antifungal. It works by damaging the protective outer layer of the fungus causing your infection.
Drug facts
Side effects of Posaconazole (Noxafil)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Diarrhea (up to 29%)
- Fever (28%)
- Nausea (27%)
- Low potassium levels (22%)
- Cough (17%)
- Rash (16%)
- Swelling of the arms or legs (16%)
- Lower blood cell counts (up to 14%)
- Inflammation of mucus membranes (14%)
- Headache (14%)
- Nosebleeds (14%)
- Vomiting (13%)
Note: Side effects above reported by adults taking the tablets for prevention of fungal infection.
Less Common Side Effects
- Constipation
- Stomach pain
- Weakness
- Chills
- High blood pressure
Posaconazole (Noxafil) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious liver problems: nausea, vomiting, stomach pain, yellowing of the skin or whites of the eyes, flu-like symptoms
- Abnormal heart rhythm: irregular heartbeat, racing heart, chest pain, dizziness
- Changes in electrolytes: nausea, vomiting, muscle cramps, muscle weakness, abnormal heartbeat, feeling tired
The following Posaconazole (Noxafil) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Abdominal or stomach pain
black, tarry stools
bloody nose
blurred vision
body aches or pain
confusion
difficult or labored breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
fever or chills
fruit-like breath odor
heavy non-menstrual vaginal bleeding
increased thirst or urination
irregular heartbeats
loss of voice
muscle pain, spasms, or twitching
nausea or vomiting
numbness or tingling in the hands, feet, lips, mouth, or fingertips
painful cold sores or blisters on the lips, nose, eyes, or genitals
painful or difficult urination
pounding in the ears
slow or fast heartbeat
small red or purple spots on the skin
sores, ulcers, or white spots on the lips, tongue, or inside the mouth
sweating
tender, swollen glands in the neck
tightness in the chest
trembling
trouble swallowing
unexplained weight loss
yellow eyes or skin
Less common
Fainting
irregular heartbeat, recurrent
Incidence not known
change in mental status
chest pain or discomfort
darkening of the skin
itching or skin rash
mental depression
seizures
sudden shortness of breath or troubled breathing
swelling of the eyes or eyelids
swelling of the face, fingers, feet, or lower legs
weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
back pain
belching
difficulty having a bowel movement (stool)
muscle stiffness
pain in the joints
trouble sleeping
Less common
Bad, unusual, or unpleasant (after) taste
change in taste
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Posaconazole (Noxafil)
Pros
- Available as a tablet and oral liquid
- Some formulations available as a lower-cost generic
- Possible option when other antifungals aren't working for oral thrush
Cons
- Some forms must be taken multiple times per day
- Can interact with many medications
- Might not be a good option during pregnancy
Pharmacist tips for Posaconazole (Noxafil)
- Continue to take posaconazole (Noxafil) even if you start to feel better. Stopping too early can cause your infection to come back and be harder to treat.
- Posaconazole (Noxafil) interacts with many medications, including alprazolam (Xanax), simvastatin (Zocor), and phenytoin (Dilantin). This isn't a complete list of all drug interactions, so please speak with your healthcare professional before starting posaconazole (Noxafil). Be sure to tell them about any over-the-counter medications, vitamins, and herbal products you take.
- Tell your care team if you experience severe diarrhea or vomiting while taking posaconazole (Noxafil). These might be signs that posaconazole (Noxafil) isn't working well to treat your infection and that you need more medical attention.
Additional tips for taking the tablets:
- You can take posaconazole (Noxafil) tablets with or without food.
- Swallow the tablets whole and don't crush, break, or chew them because this could change how the medication works in your body.
- Store the tablets at room temperature.
Additional tips for the oral suspension:
- Shake posaconazole (Noxafil) oral suspension well each time before taking a dose.
- Make sure to take posaconazole (Noxafil) oral suspension at the same time as or within 20 minutes of a full meal. This will help the medication to be absorbed by your body and work better. If you can't eat a full meal, you can take posaconazole (Noxafil) with a nutritional supplement drink (Boost, Ensure, etc.) or an acidic carbonated beverage like ginger ale.
- Only use the dosing spoon that comes with posaconazole (Noxafil) oral suspension and rinse it after each use. Don't use household spoons because this can cause you to take or give the wrong dose.
- Store posaconazole (Noxafil) oral suspension at room temperature.
Additional tips for taking Noxafil PowderMix for delayed-release oral suspension:
- Make sure to read the Instructions for Use before using Noxafil (posaconazole) PowderMix for oral suspension and keep them handy each time you mix and give the medication.
- Don't open the Noxafil (posaconazole) PowderMix foil packet until you're ready to use it.
- Only use the syringe that comes with the medication to prepare and give Noxafil (posaconazole) PowderMix.
- Once you mix Noxafil (posaconazole) PowderMix, give the dose within 1 hour and with food.
- Call your child's prescriber if they spit some of the dose out or don't take the full dose.
Common questions about Posaconazole (Noxafil)
The amount of time you should take posaconazole (Noxafil) depends on things like the reason you're taking it, how long you're at risk for infection, or how serious your infection is. If you're taking posaconazole (Noxafil) to prevent a serious fungal infection, your prescriber will likely have you take it until you're no longer at risk, such as when your immune system is stronger. If you're taking posaconazole (Noxafil) to treat fungal infection in the mouth and throat (oral thrush), treatment usually lasts 2 weeks, but can be longer if your infection isn't getting better. And if you have a severe Aspergillus infection, your healthcare team might ask you to take posaconazole (Noxafil) 6-12 weeks. Follow up with your care team to understand how long you'll need to take posaconazole (Noxafil).
No, posaconazole (Noxafil) tablets shouldn't be crushed, chewed, or split. This is because they're delayed-release tablets, meaning they're made to slowly release the medication in your body; crushing them could affect how the medication works. If you're having trouble swallowing the tablets, ask your prescriber about taking a liquid version instead. Keep in mind that if you switch between the tablet and oral suspension your dose might be different.
Dairy products aren't known to interact with posaconazole (Noxafil). If you're taking the oral suspension (including Noxafil PowderMix for oral suspension), it's recommended to take it with food, including foods that contain dairy. But if you're taking the Noxafil PowderMix, never mix the powder with milk; only mix it with the mixing liquid that comes with the kit.
Some people taking posaconazole (Noxafil) during clinical studies did experience having lower white blood cell count. But it's unclear if this was caused by posaconazole (Noxafil) or another reason. Taking posaconazole (Noxafil) with certain medications, such as Venclexta (venetoclax), can raise your risk for lower white blood cell counts. Make sure to tell your care team about all of the medications you're taking before starting posaconazole (Noxafil). They can watch your white blood cell count through blood tests.
Hair loss wasn't a commonly-reported side effect during studies of posaconazole (Noxafil). If you notice more hair falling out, contact your primary care provider so they can help you determine the cause.
No, posaconazole (Noxafil) tablets and suspension are made differently and have different dosing recommendations. If you want to switch between the tablet and liquid forms, you'll need to consult with your healthcare professional so they can make sure you're taking the correct dosage and write. you a new prescription.
Based on animal studies, posaconazole (Noxafil) can cause harm to unborn babies when taken during pregnancy. There aren't enough studies in humans to know how safe this medication is to take while pregnant. Tell your prescriber right away if you become pregnant while taking posaconazole (Noxafil) because they might ask you to consider other options.
If you miss your dose of posaconazole (Noxafil), take it as soon as you remember. But if it's almost time for your next dose (less than 12 hours until the next dose for the tablets), skip the dose you missed and just take your next dose at your regular time. Never double up or take extra doses of posaconazole (Noxafil) to make up for missed doses. If you have questions about missing a dose, contact your care team.
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Risks and warnings for Posaconazole (Noxafil)
Posaconazole (Noxafil) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of posaconazole not working well
Call for medical help and let your healthcare team know right away if you have severe diarrhea or vomiting. These might be signs that posaconazole (Noxafil) isn't working well to treat your fungal infection. If so, you'll need more medical attention immediately from your care team.
Liver damage
- Risk factors: History of liver problems
Posaconazole (Noxafil) can cause liver problems. Most of the time, you won't experience any symptoms. But your healthcare team might note higher liver enzyme levels on blood work that checks your liver health. Typically, your liver enzyme levels should go back to the normal range once you stop taking posaconazole (Noxafil). But rarely, people have experienced serious liver problems that were life-threatening. As a precaution, your healthcare team might order blood work regularly during treatment to check your liver health. If there are signs of liver problems, they might ask you to stop taking posaconazole (Noxafil). Get medical help right away if you feel symptoms of serious liver problems, such as unexplained stomach pain, nausea, or vomiting, dark urine, pale stools, or yellowing of your skin or eyes.
QT prolongation (heart rhythm problem)
- Risk factors: History of abnormal heart rhythm | Taking other medications that cause heart rhythm problem | Taking medications that cause posaconazole (Noxafil) to build up in your body
Posaconazole (Noxafil) can cause a serious heart rhythm problem called QT prolongation. The risk is higher for people who already have heart rhythm problems or are taking medications that also have a risk of causing heart rhythm problems. Let your healthcare team know about all medications and supplements you're taking so they can check if you're at higher risk for QT prolongation.
Changes in electrolytes
Posaconazole (Noxafil) can cause changes to electrolytes levels in your body like potassium, magnesium, and calcium. Usually, this change is minor and can be corrected with supplements. But if these levels drop too low, they can cause problems with your heart. Make sure you get any blood tests ordered by your prescriber done on time while taking posaconazole (Noxafil). This will help them catch problems earlier.
Multiple drug interactions
Posaconazole (Noxafil) is known to interact with many medications, including over-the-counter vitamins and herbals. Some of these interactions can be dangerous or life-threatening. Make sure to tell both your healthcare team about all medications and over-the-counter products you are taking before you start posaconazole (Noxafil), even if you only take them once in a while or as needed.
Interaction with transplant medications
- Risk factors: Taking calcineurin-inhibitors
Posaconazole (Noxafil) interacts with medications known as calcineurin inhibitors, which are usually taken by people who have had organ transplants or have certain immune conditions. Examples include cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf). Posaconazole (Noxafil) can cause these medications to build up in your body. This can cause serious problems like brain damage (leukoencephalopathy) and kidney damage, which can be life-threatening. Be sure to tell your care team all the medications you take before starting posaconazole (Noxafil) so they can help you check for interactions.
Interaction with midazolam
Posaconazole (Noxafil) interacts with midazolam (Seizalam), a medication used for seizures and anesthesia. Posaconazole (Noxafil) causes midazolam to build up in your body, making it more likely you'll have side effects or have trouble waking up. This interaction is life-threatening, so you shouldn't take these two medications together. Make sure you tell your prescriber if you take midazolam before starting posaconazole (Noxafil). If you need to have any surgical procedures done while taking posaconazole (Noxafil), be sure to tell your surgeon you are taking this medication so they can pick anesthesia that won't interact with posaconazole (Noxafil).
Interaction with vincristine
Posaconazole (Noxafil) interacts with a cancer medication called vincristine. Taking these medications together can cause seizures, nerve damage, or bowel blockages. Make sure you tell the healthcare professional prescribing posaconazole (Noxafil) if you take any cancer medications. Your healthcare team might only ask you to take this combination if there are no safer alternative treatments available. If so, they'll go over the risks and benefits of treatment and monitor you closely for side effects.
Interaction with venetoclax
Posaconazole (Noxafil) interacts with a medication called Venclexta (venetoclax). Taking these medications together can raise the risk of life-threatening side effects, such as tumor lysis syndrome (TLS) and serious infections. Review of list of your current medications with your prescriber before taking posaconazole (Noxafil). Your healthcare team can help you check for interactions and talk with you about alternative options if needed.
Problems in people with hereditary fructose intolerance (Noxafil PowderMix only)
Noxafil PowderMix for delayed-release oral suspension contains sorbitol, which can cause life-threatening problems in people with hereditary fructose intolerance (HFI). Some problems include dangerously low blood sugar levels, lactic acidosis, and liver failure. Tell your prescriber if you have a history of HFI so they can prescribe the safest formulation of posaconazole (Noxafil) for you.
Posaconazole (Noxafil) dosage
Interactions between Posaconazole (Noxafil) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Alfuzosin
- Alprazolam
- Amiodarone
- Aripiprazole
- Astemizole
- Atorvastatin
- Bedaquiline
- Bepridil
- Buprenorphine
- Cisapride
- Citalopram
- Clarithromycin
- Clozapine
- Colchicine
- Conivaptan
- Crizotinib
- Dabrafenib
- Dasatinib
- Dihydroergotamine
- Disopyramide
- Dofetilide
- Domperidone
- Donepezil
- Dronedarone
- Eletriptan
- Eliglustat
- Encorafenib
- Entrectinib
- Eplerenone
- Ergonovine
- Ergotamine
- Erythromycin
- Flibanserin
- Fluvastatin
- Glasdegib
- Halofantrine
- Haloperidol
- Iloperidone
- Isavuconazonium Sulfate
- Itraconazole
- Ivabradine
- Ivosidenib
- Lapatinib
- Lomitapide
- Lopinavir
- Lovastatin
- Lumefantrine
- Lurasidone
- Macimorelin
- Maraviroc
- Mefloquine
- Mesoridazine
- Methadone
- Methylergonovine
- Methysergide
- Mifepristone
- Mirtazapine
- Naloxegol
- Nelfinavir
- Nilotinib
- Nimodipine
- Ondansetron
- Osilodrostat
- Pazopanib
- Pimozide
- Piperaquine
- Propafenone
- Quetiapine
- Quinidine
- Quinine
- Ranolazine
- Ribociclib
- Saquinavir
- Selpercatinib
- Simvastatin
- Sirolimus
- Solifenacin
- Sorafenib
- Sparfloxacin
- Sunitinib
- Tacrolimus
- Tamoxifen
- Telithromycin
- Terfenadine
- Thioridazine
- Tolvaptan
- Toremifene
- Trazodone
- Ubrogepant
- Vardenafil
- Vemurafenib
- Venetoclax
- Vilanterol
- Voclosporin
- Voriconazole
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acalabrutinib
- Ado-Trastuzumab Emtansine
- Alfentanil
- Amitriptyline
- Amprenavir
- Anagrelide
- Apalutamide
- Apomorphine
- Aprepitant
- Arsenic Trioxide
- Asenapine
- Avanafil
- Avapritinib
- Axitinib
- Azithromycin
- Benzhydrocodone
- Bosutinib
- Brentuximab Vedotin
- Brexpiprazole
- Brigatinib
- Bromocriptine
- Buserelin
- Cabazitaxel
- Cabozantinib
- Calcifediol
- Capmatinib
- Cariprazine
- Ceritinib
- Chloroquine
- Chlorpromazine
- Cilostazol
- Cimetidine
- Ciprofloxacin
- Clofazimine
- Clomipramine
- Cobimetinib
- Codeine
- Copanlisib
- Cyclobenzaprine
- Cyclosporine
- Daclatasvir
- Deflazacort
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Dexamethasone
- Dihydrocodeine
- Docetaxel
- Dolasetron
- Doxepin
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droperidol
- Duvelisib
- Ebastine
- Efavirenz
- Elagolix
- Elexacaftor
- Enzalutamide
- Eribulin
- Erlotinib
- Escitalopram
- Esomeprazole
- Eszopiclone
- Etravirine
- Everolimus
- Famotidine
- Fedratinib
- Felbamate
- Fentanyl
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Fluticasone
- Formoterol
- Fosamprenavir
- Fosaprepitant
- Foscarnet
- Fosphenytoin
- Fostemsavir
- Galantamine
- Gatifloxacin
- Gemifloxacin
- Gonadorelin
- Goserelin
- Granisetron
- Histrelin
- Hydrocodone
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibrutinib
- Ibutilide
- Idelalisib
- Ifosfamide
- Imipramine
- Inotuzumab Ozogamicin
- Irinotecan
- Irinotecan Liposome
- Istradefylline
- Ivacaftor
- Larotrectinib
- Lasmiditan
- Lefamulin
- Lemborexant
- Lenvatinib
- Levofloxacin
- Levomilnacipran
- Lofexidine
- Lorlatinib
- Lumacaftor
- Lumateperone
- Lurbinectedin
- Macitentan
- Manidipine
- Meperidine
- Methotrimeprazine
- Metronidazole
- Midazolam
- Midostaurin
- Mizolastine
- Moricizine
- Moxifloxacin
- Nafarelin
- Neratinib
- Nifedipine
- Norfloxacin
- Octreotide
- Ofloxacin
- Olanzapine
- Olaparib
- Osimertinib
- Oxaliplatin
- Oxycodone
- Ozanimod
- Palbociclib
- Paliperidone
- Panobinostat
- Papaverine
- Paroxetine
- Pasireotide
- Pemigatinib
- Pentamidine
- Pentazocine
- Perphenazine
- Pexidartinib
- Phenytoin
- Pimavanserin
- Pipamperone
- Pitolisant
- Ponatinib
- Ponesimod
- Pralsetinib
- Probucol
- Procainamide
- Prochlorperazine
- Promethazine
- Protriptyline
- Reboxetine
- Regorafenib
- Retapamulin
- Rifabutin
- Rifampin
- Rimegepant
- Risperidone
- Ritonavir
- Romidepsin
- Ruxolitinib
- Salmeterol
- Selumetinib
- Sertindole
- Sertraline
- Sevoflurane
- Simeprevir
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sonidegib
- Sotalol
- Sufentanil
- Sulpiride
- Sultopride
- Suvorexant
- Tamsulosin
- Tazemetostat
- Telaprevir
- Telavancin
- Tetrabenazine
- Tezacaftor
- Thiotepa
- Tolterodine
- Trabectedin
- Tramadol
- Triclabendazole
- Trimipramine
- Triptorelin
- Valbenazine
- Vandetanib
- Venlafaxine
- Vilazodone
- Vinblastine
- Vincristine
- Vincristine Sulfate Liposome
- Vinflunine
- Vinorelbine
- Vorapaxar
- Vorinostat
- Voxelotor
- Warfarin
- Zanubrutinib
- Zolpidem
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aripiprazole Lauroxil
- Lorazepam
- Topiramate
How much does Posaconazole (Noxafil) cost?
Posaconazole (Noxafil) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Posaconazole (Noxafil) will not be safe for you to take.
- Allergic to azole antifungals
- Taking posaconazole (Noxafil) together with sirolumus (Rapamune)
- Taking posaconazole (Noxafil) with certain medications that can cause QT prolongation (e.g., pimozide, quinidine)
- Taking posaconazole (Noxafil) with certain statin medications (e.g., atorvastatin (Lipitor), lovastatin, and simvastatin (Zocor))
- Taking posaconazole (Noxafil) with ergot alkaloids (e.g., ergotamine and dihydroergotamine)
- Taking posaconazole (Noxafil) with Venclexta (venetoclax)
- Hereditary fructose intolerance (Noxafil Powder Mix for delayed-release oral suspension only)
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