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

 

 

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:


 

 

Selected Posaconazole (POS) Drug Interactions

 

cimetidine, phenytoin or rifabutin

  • results in decreased POS concentrations
  • do not administer concomitantly

cisapride, pimozide, quinidine

  • may result in cardiac arrhythmias due to decreased metabolism of these drugs
  • concomitant use is contraindicated

cyclosporine (CYA), tacrolimus (TAC), sirolimus

  • results in decreased metabolism of these drugs
  • ↓ CYA dose by 75% when POS initiated
  • ↓ TAC dose by 30% when POS initiated
  • monitor serum concentrations of CYA, TAC and sirolimus and adjust dose as needed

 

Dosing

 

oropharyngeal candidiasis refractory to fluconazole

400mg bid

zygomycosis

200mg qid or 400mg bid

Dose adjustment is not required for renal dysfunction.   Pharmacokinetic data is not sufficient to determine if dose adjustment is   required in hepatic dysfunction.

 

  

Posaconazole (POS) Approval/Administration

 

Written by Amy Morgan 5/20/07

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