HOSPITAL OF THE UNIVERSITY OF PENSYLVANIA

Guidelines for Use and Administration of Posaconazole (Noxafil ®)

The Antibiotic Subcommittee of the Pharmacy & Therapeutics Committee has reviewed and discussed the clinical, pharmacokinetic, drug interaction and safety data of the oral triazole antifungal agent, posaconazole.   Although posaconazole has been shown to be effective in the treatment various fungal infections, reduced drug absorption in patients unable to ingest food or nutritional supplements may result in therapeutic failure.   Therefore, use of posaconazole is limited to specific, difficult to treat infections in patients who are likely to achieve therapeutic drug levels.   In addition to the following guidelines, a flow diagram has been developed and is attached below.

Indications for Posaconazole Use at HUP

Posaconazole is a Category III antimicrobial agent.   All use requires approval from the Antimicrobial Management Service (AMS) [beeper 306-0336].   Posaconazole will be approved for use for the treatment of the following infections in patients who are able to maintain adequate nutrition.

1. oropharyngeal candidiasis refractory to treatment with fluconazole
2. zygomycosis in patients who are intolerant of or refractory to conventional antifungal therapy

Ordering Posaconazole

• Obtain AMS approval (beeper 306-0336)
• Order posaconazole in Sunrise (see dosing chart below)
• Order a Nutrition Support Consult in Sunrise (type “posaconazole” in the message field)

Posaconazole Administration

Posaconazole is available as an oral suspension.   It must be administered with a full meal or nutritional supplement to achieve adequate drug levels.   To ensure optimal absorption, the following should occur:

• The Nutrition Support Service (NSS) will provide a consult within 24 hours of ordering the drug to assess food intake and order nutritional supplements if necessary.   A dietitian will instruct the patient to ingest a nutritional supplement if he/she ingests ≤ 50% of a meal.   Nurses and pharmacists can also reinforce this concept to patients.   The NSS will provide follow up consultation every 3-4 days.   Initial doses of posaconazole should not be held while awaiting the Nutrition Support consult.
• Posaconazole administration times should be scheduled around meals.   If the patient misses a meal (e.g. NPO for a study) posaconazole should be administered at the scheduled time and the nurse should document that the drug was administered without food.

• The team pharmacist will discuss the patient’s food/nutritional supplement intake with the nurse on a daily basis.   The pharmacist will notify the physician and recommend consultation with the Infectious Diseases Consult or the Antimicrobial Management Service if:
•  the patient is not eating >50% of meals or ingesting nutritional supplements consistently
• the patient is made NPO, off the patient care unit for testing, etc. and misses ≥ 2 doses in the first two weeks of therapy or ≥   4 doses after the first two weeks of therapy
• any other condition is present that would decrease drug absorption (e.g. vomiting, diarrhea).
• Posaconazole should not be administered through nasogastric or jejunostomy tubes unless recommended by the ID Consult service.

Selected Posaconazole (POS) Drug Interactions

Dosing

Posaconazole (POS) Approval/Administration

Written by Amy Morgan 5/20/07

  Back to Table of Contents