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Posaconazole: Antifungal Uses, Dosage, Side Effects & Interactions
Summary of Key Points
Posaconazole is an antifungal medication used to treat severe fungal infections, including aspergillosis, candidiasis, and mucormycosis. It works by inhibiting the growth of fungi in the body. Posaconazole is often prescribed when other antifungal treatments have not been effective or are poorly tolerated. Available in various forms and strengths, it is essential to follow your healthcare provider’s instructions carefully. Always consult your doctor before making any changes to your dosage.
Names of Medication
US Brand Name: Noxafil
Generic Name: Posaconazole
The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. The generic name (Posaconazole) is listed in parentheses.
Pharmacologic Category
Antifungal Agent, Azole Derivative
Other medications in this category include:
- Fluconazole
- Itraconazole
- Voriconazole
Posaconazole Dosage
Posaconazole is used to treat a variety of fungal infections. The dosage will depend on the specific infection being treated. Always follow your healthcare provider’s instructions and consult them before making any adjustments to your dose. If you need to speak with a doctor, you can schedule a telemedicine appointment with one of our providers at any time.
Aspergillosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Candidiasis (Oropharyngeal)
Initial Dose: 100 mg once daily for 1 day
Maintenance Dose: 100 mg once daily for 13 days
Mucormycosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Histoplasmosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Blastomycosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Coccidioidomycosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Fusariosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Sporotrichosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Cryptococcosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Zygomycosis
Loading Dose: 300 mg twice daily on the first day
Maintenance Dose: 300 mg once daily
Duration: Continue for the duration of the infection, as determined by your doctor.
Dosage Forms and Strengths
Posaconazole is available in the following forms and strengths:
- Oral Suspension: 40 mg/mL
- Delayed-Release Tablets: 100 mg
- Intravenous Solution: 300 mg/16.7 mL
Administration Instructions for Posaconazole
Take Posaconazole exactly as prescribed by your healthcare provider. Swallow the delayed-release tablets whole with food. The oral suspension should be taken with a full meal or a nutritional supplement to ensure proper absorption. If you are receiving the intravenous form, it will be administered by a healthcare professional. Do not crush or chew the tablets. If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at once.
Contraindications for Posaconazole
A contraindication is a condition or factor that makes the use of a particular medication unsafe or inappropriate. If you have any of the following conditions, taking Posaconazole may not be safe. Always consult your healthcare provider before starting any new medication.
Allergic reaction to Posaconazole or similar antifungal medications: If you’ve had an allergic reaction to Posaconazole or other azole antifungals (such as fluconazole or itraconazole), taking Posaconazole could trigger a severe allergic response, including symptoms like rash, swelling, or difficulty breathing.
Liver disease: Posaconazole is processed by the liver. If you have liver disease, your body may not metabolize the medication properly, leading to higher drug levels and an increased risk of side effects.
Heart rhythm disorders (QT prolongation): Posaconazole can affect the heart’s electrical activity, potentially worsening conditions like QT prolongation, which may lead to dangerous heart rhythms.
Kidney disease: If you have kidney problems, your body may not filter the medication effectively, increasing the risk of side effects.
Use of certain medications (see Drug to Drug Interactions): Some medications can interact with Posaconazole, increasing the risk of serious side effects or reducing the effectiveness of either drug.
Drug to Drug Interactions
Posaconazole, a powerful antifungal medication, can interact with various drugs, potentially leading to harmful effects or reducing the effectiveness of either medication. It’s crucial to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some common medications that may interact with Posaconazole:
- Statins: Lovastatin (Mevacor), Simvastatin (Zocor) – Posaconazole can increase the levels of these cholesterol-lowering medications, which may lead to muscle damage or liver problems.
- Blood thinners: Warfarin (Coumadin) – Posaconazole may enhance the effects of warfarin, raising the risk of bleeding.
- Immunosuppressants: Cyclosporine (Neoral), Tacrolimus (Prograf) – Posaconazole may elevate the levels of these drugs, potentially causing kidney damage or other serious side effects.
- Antiarrhythmics: Quinidine (Quinidex), Amiodarone (Pacerone) – Posaconazole can increase the risk of abnormal heart rhythms when combined with these medications.
- Anticonvulsants: Phenytoin (Dilantin), Carbamazepine (Tegretol) – These drugs can reduce Posaconazole’s effectiveness, making it less potent in treating fungal infections.
Posaconazole in Pregnancy
Is it Safe to Take Posaconazole During Pregnancy?
There is limited information on the use of Posaconazole during pregnancy. While animal studies suggest potential risks to the fetus, there isn’t enough data to confirm whether these risks apply to humans. As a result, Posaconazole should only be used during pregnancy if the potential benefits outweigh the risks. If you are pregnant or planning to become pregnant, consult your healthcare provider before starting Posaconazole. They can help you weigh the risks and benefits and may recommend alternative treatments if necessary.
Posaconazole While Breastfeeding
Is it Safe to Take Posaconazole While Breastfeeding?
It is not clear whether Posaconazole passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally recommended to avoid breastfeeding while taking Posaconazole. If you are breastfeeding or planning to breastfeed, discuss your options with your healthcare provider. They can help you decide whether to stop breastfeeding or switch to a different antifungal treatment.
Estimated Cost of Posaconazole
The cost of Posaconazole can vary depending on your location and pharmacy. Without insurance, a 30-day supply of Posaconazole (300 mg daily) is estimated to cost between $3,000 and $4,000 with a GoodRx coupon. Be sure to check with your pharmacy for the most accurate pricing, and consider using discount programs or coupons to help reduce costs.
Possible Alternatives to Posaconazole
If Posaconazole is not suitable for you, alternative treatments or lifestyle changes may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options.
- Aspergillosis: Alternatives include antifungal medications like voriconazole or amphotericin B. In some cases, surgery may be required to remove infected tissue.
- Candidiasis: Fluconazole or echinocandins (such as caspofungin) are common alternatives. Good hygiene and managing blood sugar levels can also help prevent recurrent infections.
- Mucormycosis: Amphotericin B or isavuconazole are often used as alternatives. Early diagnosis and treatment are crucial for managing this serious infection.
- Histoplasmosis: Itraconazole is commonly used as an alternative. In severe cases, amphotericin B may be necessary.
- Blastomycosis: Itraconazole or amphotericin B are often used as alternatives. Treatment may be prolonged, so regular follow-ups with your healthcare provider are important.
- Coccidioidomycosis: Fluconazole or itraconazole are common alternatives. In some cases, no treatment is needed, but severe infections may require long-term antifungal therapy.
- Fusariosis: Voriconazole or amphotericin B are often used as alternatives. Early intervention is key, as this infection can be difficult to treat.
- Sporotrichosis: Itraconazole is the most common alternative treatment. Potassium iodide may be used in some cases, though this is less common today.
- Cryptococcosis: Fluconazole or amphotericin B are typically used as alternatives. In severe cases, combination therapy may be required.
- Zygomycosis: Amphotericin B or isavuconazole are often used as alternatives. This serious infection requires prompt treatment.
Recent Updates on Posaconazole Research
Recent studies have explored expanding Posaconazole’s use for a broader range of fungal infections, particularly in immunocompromised patients. Ongoing research is also investigating the effectiveness of Posaconazole in combination with other antifungal agents to improve outcomes in difficult-to-treat infections like mucormycosis and fusariosis. Additionally, new formulations of Posaconazole, including delayed-release tablets and intravenous options, have been developed to enhance absorption and reduce side effects. These advancements may offer more flexible treatment options for patients with severe fungal infections.
