NOXAFIL ORAL SUSPENSION Rx
Generic Name and Formulations:
Posaconazole 40mg/mL; cherry flavor.
Merck & Co., Inc.
Indications for NOXAFIL ORAL SUSPENSION:
Prophylaxis against invasive Aspergillus and Candida infections, in patients at high risk due to being severely immunocompromised, such as hematopoietic stem cell transplant recipients with Graft vs. Host Disease (GVHD) or those with hematologic malignancies with prolonged neutropenia due to chemotherapy. Treatment of oropharyngeal candidiasis, including refractory to itraconazole and/or fluconazole.
Take within 20 mins after a full meal; may take with liquid nutritional supplement or an acidic carbonated beverage (eg, gingerale) if cannot eat a full meal or del-rel tabs are not an option. ≥13yrs: Invasive fungal prophylaxis: 200mg 3 times daily, until recovery from neutropenia or immunosuppression. Oropharyngeal candidiasis: 100mg twice daily on Day 1, then 100mg once daily for 13 days; refractory: 400mg twice daily.
<13yrs: not established.
Concomitant sirolimus, ergot alkaloids, or HMG-CoA reductase inhibitors (eg, atorvastatin, lovastatin, simvastatin). Drugs that cause QT prolongation and are metabolized by CYP3A4 (eg, quinidine, pimozide).
Tabs and oral susp are not interchangeable. Inj: avoid in moderate or severe renal impairment (eGFR <50mL/min); if needed, monitor and consider switching to oral therapy if creatinine levels increase. Proarrhythmic conditions. Correct potassium, calcium, magnesium levels before starting. Evaluate and monitor LFTs before and during therapy; consider discontinuing if liver disease occurs. Patients who cannot eat a full meal or tolerate an oral nutritional supplement, or those with severe renal impairment, severe diarrhea, vomiting, or >120kg: monitor for breakthrough fungal infections. Pregnancy. Nursing mothers: not recommended.
See Contraindications. Avoid drugs that lower posaconazole levels (eg, rifabutin, phenytoin, efavirenz, fosamprenavir); monitor for breakthrough fungal infections. Potentiates calcineurin-inhibitors (eg, cyclosporine, tacrolimus); monitor trough levels frequently during and at discontinuation of posaconazole; adjust tacrolimus or cyclosporine doses. Potentiates CYP3A4 substrates (eg, ritonavir, atazanavir, calcium channel blockers, vinca alkaloids, rifabutin, phenytoin), digoxin; monitor and consider dose reduction. Neurotoxicity with concomitant vincristine; reserve azole antifungals for those who have no alternative treatment options. Prolonged hypnotic and sedative effects with concomitant midazolam or other benzodiazepines (eg, alprazolam, triazolam). Monitor glucose levels with glipizide. Susp: avoid concomitant cimetidine, esomeprazole, metoclopramide; if needed, monitor for breakthrough fungal infections.
Fever, diarrhea, nausea, vomiting, headache, hypokalemia, cough, rigors, fatigue, anorexia, hypertension, abdominal pain, constipation, rash; lab abnormalities (eg, anemia, neutropenia, thrombocytopenia, increased liver enzymes), arrhythmias, QT prolongation.
Fecal (major), renal.
Tabs—60; Susp—105mL (w. dosing spoon); Vials—1