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Noxafil
posaconazole
Adult Dosing .
Dosage forms: DR TAB: 100 mg; SUSPENSION: 40 mg per mL; INJ: various
Special Note
- [equivalency or interchangeability info]
- Info: posaconazole suspension not bioequivalent or interchangeable with tab and IV form; reassess dose if switching between products
invasive fungal infection prophylaxis, immunocompromised patients
- [delayed-release form]
- Dose: 300 mg DR PO qd; Start: 300 mg DR PO bid x1 day; Info: 1st-line tx for invasive aspergillosis prophylaxis; duration based on immunosuppression recovery; do not cut/crush/chew DR tab
- [suspension form]
- Dose: 200 mg suspension PO tid; Info: duration based on immunosuppression recovery; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
- [IV form]
- Dose: 300 mg IV q24h; Start: 300 mg IV q12h x1 day; Info: duration based on immunosuppression recovery
candidiasis, oropharyngeal
- [suspension form]
- Dose: 100 mg suspension PO qd x13 days; Start: 100 mg suspension PO bid x1 day; Info: give with full meal, liquid nutrient supplement, or acidic carbonated beverage
candidiasis, refractory oropharyngeal
- [suspension form]
- Dose: 400 mg suspension PO bid x3 days, then 400 mg suspension PO qd for up to 28 days; Info: for itraconazole- or fluconazole-refractory disease; duration based on underlying disease severity, tx response; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
aspergillosis, invasive
- [delayed-release form]
- Dose: 300 mg DR PO qd for at least 6-12wk; Start: 300 mg DR PO bid x1 day; Info: do not cut/crush/chew DR tab
- [IV form]
- Dose: 300 mg IV q24h for at least 6-12wk; Start: 300 mg IV q12h x1 day
- [suspension form (off-label)]
- Dose: 200 mg suspension PO tid for at least 6-12wk; Info: give with full meal, liquid nutrient supplement, or acidic carbonated beverage
candidiasis, esophageal (off-label)
- [delayed-release form]
- Dose: 300 mg DR PO qd; Info: for fluconazole-refractory disease; do not cut/crush/chew DR tab
- [suspension form]
- Dose: 400 mg suspension PO bid; Info: for fluconazole-refractory disease; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
mucormycosis, invasive (off-label)
- [delayed-release form]
- Dose: 300 mg DR PO qd; Start: 300 mg DR PO bid x1 day; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; do not cut/crush/chew DR tab
- [IV form]
- Dose: 300 mg IV q24h; Start: 300 mg IV q12h x1 day; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; consider switching to PO posaconazole or PO isavuconazole for maintenance tx
- [suspension form]
- Dose: 200 mg suspension PO qid; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
renal dosing
- [PO route]
- renal impairment: no adjustment; Info: monitor for breakthrough invasive fungal infection if eGFR <20
- HD/PD: not defined
- [IV route]
- eGFR <50: avoid use; Info: risk of IV vehicle accumulation
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: DR TAB: 100 mg; SUSPENSION: 40 mg per mL; DR SUSPENSION: 30 mg per mL; INJ: various
Special Note
- [equivalency or interchangeability info]
- Info: posaconazole IR suspension not bioequivalent or interchangeable with tab, DR suspension, and IV form; reassess dose if switching between products
invasive fungal infection prophylaxis, immunocompromised patients
- [delayed-release suspension form, 2 yo and older, 10-11 kg]
- Dose: 90 mg DR suspension PO qd; Start: 90 mg DR suspension PO bid x1 day; Info: duration based on immunosuppression recovery; give with food
- [delayed-release suspension form, 2 yo and older, 12-16 kg]
- Dose: 120 mg DR suspension PO qd; Start: 120 mg DR suspension PO bid x1 day; Info: duration based on immunosuppression recovery; give with food
- [delayed-release suspension form, 2 yo and older, 17-20 kg]
- Dose: 150 mg DR suspension PO qd; Start: 150 mg DR suspension PO bid x1 day; Info: duration based on immunosuppression recovery; give with food
- [delayed-release suspension form, 2 yo and older, 21-25 kg]
- Dose: 180 mg DR suspension PO qd; Start: 180 mg DR suspension PO bid x1 day; Info: duration based on immunosuppression recovery; give with food
- [delayed-release suspension form, 2 yo and older, 26-35 kg]
- Dose: 210 mg DR suspension PO qd; Start: 210 mg DR suspension PO bid x1 day; Info: duration based on immunosuppression recovery; give with food
- [delayed-release suspension form, 2 yo and older, 36-40 kg]
- Dose: 240 mg DR suspension PO qd; Start: 240 mg DR suspension PO bid x1 day; Info: duration based on immunosuppression recovery; give with food
- [delayed-release tablet form, 2 yo and older, >40 kg]
- Dose: 300 mg DR tab PO qd; Start: 300 mg DR tab PO bid x1 day; Info: duration based on immunosuppression recovery; do not cut/crush/chew DR tab
- [immediate-release suspension form, 13 yo and older]
- Dose: 200 mg IR suspension PO tid; Info: duration based on immunosuppression recovery; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
- [IV form, 2 yo and older, >10 kg]
- Dose: 6 mg/kg/dose IV q24h; Start: 6 mg/kg/dose IV q12h x1 day; Max: 300 mg/dose; Info: duration based on immunosuppression recovery
candidiasis, oropharyngeal
- [immediate-release suspension form, 13 yo and older]
- Dose: 100 mg IR suspension PO qd x13 days; Start: 100 mg IR suspension PO bid x1 day; Info: give with full meal, liquid nutrient supplement, or acidic carbonated beverage
candidiasis, refractory oropharyngeal
- [immediate-release suspension form, 13 yo and older]
- Dose: 400 mg IR suspension PO bid x3 days, then 400 mg IR suspension PO qd for up to 28 days; Info: for itraconazole- or fluconazole-refractory disease; duration based on underlying disease severity, tx response; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
aspergillosis, invasive
- [delayed-release suspension form, 2 yo and older, 10-16 kg]
- Dose: 120 mg DR suspension PO qd for at least 6-12wk; Start: 120 mg DR suspension PO bid x1 day; Info: give with food
- [delayed-release suspension form, 2 yo and older, 17-20 kg]
- Dose: 150 mg DR suspension PO qd for at least 6-12wk; Start: 150 mg DR suspension PO bid x1 day; Info: give with food
- [delayed-release suspension form, 2 yo and older, 21-25 kg]
- Dose: 180 mg DR suspension PO qd for at least 6-12wk; Start: 180 mg DR suspension PO bid x1 day; Info: give with food
- [delayed-release suspension form, 2 yo and older, 26-35 kg]
- Dose: 210 mg DR suspension PO qd for at least 6-12wk; Start: 210 mg DR suspension PO bid x1 day; Info: give with food
- [delayed-release suspension form, 2 yo and older, 36-40 kg]
- Dose: 240 mg DR suspension PO qd for at least 6-12wk; Start: 240 mg DR suspension PO bid x1 day; Info: give with food
- [delayed-release tablet form, 2 yo and older, >40 kg]
- Dose: 300 mg DR tab PO qd for at least 6-12wk; Start: 300 mg DR tab PO bid x1 day; Info: do not cut/crush/chew DR tab
- [IV form, 2 yo and older, >10 kg]
- Dose: 6 mg/kg/dose IV q24h for at least 6-12wk; Start: 6 mg/kg/dose IV q12h x1 day; Max: 300 mg/dose
mucormycosis, invasive (off-label)
- [immediate-release suspension form, 4 wk old-12 yo]
- Dose: individualize dose; Start: 6 mg/kg/day suspension PO divided tid; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
- [immediate-release suspension form, 13 yo and older]
- Dose: 200 mg suspension PO qid; Alt: 400 mg suspension PO bid; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; give with full meal, liquid nutrient supplement, or acidic carbonated beverage
- [delayed-release tablet form, 13 yo and older]
- Dose: 300 mg DR PO qd; Start: 300 mg DR PO bid x1 day; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; do not cut/crush/chew DR tab
- [IV form, 13 yo and older]
- Dose: 300 mg IV q24h; Start: 300 mg IV q12h x1 day; Info: continue tx until permanent immunosuppression reversal and complete response on imaging; consider switching to PO posaconazole or PO isavuconazole for maintenance tx
renal dosing
- [PO route]
- renal impairment: no adjustment; Info: monitor for breakthrough invasive fungal infection if eGFR <20
- HD/PD: not defined
- [IV route]
- eGFR <50: avoid use; Info: risk of IV vehicle accumulation
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- fructose intolerance, hereditary (sorbitol-containing form)
- pregnancy
- caution: eGFR <20
- caution: eGFR 20-49 (IV use)
- caution: electrolyte abnormalities
- caution: long QT syndrome, congenital
- caution: QT prolongation
- caution: QT prolongation family history
- caution: torsades de pointes history
- caution: ventricular arrhythmia
- caution: bradycardia
- caution: cardiomyopathy
- caution: MI, recent
- caution: CHF
- caution: wt >120 kg
- caution: diarrhea, severe (PO form)
- caution: vomiting, severe (PO form)
Drug Interactions .
Overview
posaconazole
azole antifungal
Interaction Characteristics:
- UGT1A4 substrate
- P-gp substrate
- CYP3A4 inhibitor, strong
- P-gp inhibitor, weak
- affected by altered gastrointestinal motility
- gastric pH sensitive
- hypokalemia
- potential for modified drug release
- prolongs QT interval (conditional)
Other Info
- some formulations of posaconazole contain sorbitol
- avoid combo with beverages or products containing ethanol and posaconazole delayed-release (DR) oral suspension; combo may incr. posaconazole release rate, levels, risk of adverse effects
sorbitol (in some formulations)
excipient
Interaction Characteristics:
- colonic mucosal ulceration
- increases gastrointestinal motility
Contraindicated
- adagrasib
- alfuzosin
- alprazolam
- amiodarone
- apalutamide
- artemether/lumefantrine
- atorvastatin
- bedaquiline
- cabozantinib
- ceritinib
- cisapride
- clarithromycin
- colchicine
- conivaptan
- crizotinib
- dihydroergotamine
- disopyramide
- dofetilide
- domperidone
- dordaviprone
- dronedarone
- eliglustat
- encorafenib
- eplerenone
- ergotamine
- erythromycin
- fexinidazole
- finerenone
- flibanserin
- gepirone
- gepotidacin
- gilteritinib
- glasdegib
- haloperidol
- isavuconazonium
- ivabradine
- ivosidenib
- lefamulin
- levoketoconazole
- lomitapide
- lonafarnib
- lovastatin
- lurasidone
- methadone
- mobocertinib
- naloxegol
- nilotinib
- oliceridine
- pacritinib
- pimozide
- propafenone
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- ranolazine
- revumenib
- ribociclib
- romidepsin
- sebetralstat
- selpercatinib
- silodosin
- simvastatin
- sirolimus
- suzetrigine
- taletrectinib
- thioridazine
- tolvaptan
- toremifene
- tramadol
- triazolam
- ubrogepant
- vemurafenib
- venetoclax
- voclosporin
Avoid/Use Alternative
- acalabrutinib
- ado-trastuzumab emtansine
- alfentanil
- almotriptan
- apixaban
- aprepitant
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- arsenic trioxide
- avanafil
- avapritinib
- axitinib
- bosentan
- bosutinib
- brigatinib
- bromocriptine
- budesonide
- budesonide rectal
- buprenorphine
- buspirone
- cabazitaxel
- capivasertib
- carbamazepine
- cariprazine
- cimetidine
- cobimetinib
- codeine
- copanlisib
- dabigatran
- dabrafenib
- danshen
- daridorexant
- dasatinib
- defactinib
- dexamethasone
- dexlansoprazole
- dicloxacillin
- dihydrocodeine
- docetaxel
- doxorubicin
- duvelisib
- efavirenz
- elacestrant
- elagolix
- elbasvir
- eletriptan
- elinzanetant
- ensartinib
- entrectinib
- ephedra
- erdafitinib
- erlotinib
- esomeprazole
- estazolam
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethanol (alcoholic beverage)
- ethanol (in some formulations)
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- etoposide
- etrasimod
- everolimus
- fedratinib
- fentanyl
- fesoterodine
- fluticasone propionate
- fosamprenavir
- fosaprepitant
- fosfomycin injection
- fosphenytoin
- futibatinib
- grazoprevir
- hydrocodone
- hydroxychloroquine
- idelalisib
- imlunestrant
- irinotecan
- ivacaftor
- ixabepilone
- lamivudine
- lansoprazole
- lapatinib
- larotrectinib
- lemborexant
- lenacapavir
- leniolisib
- lopinavir/ritonavir
- lorlatinib
- lumacaftor/ivacaftor
- lurbinectedin
- macitentan
- mefloquine
- meperidine
- methylergonovine
- midazolam
- midostaurin
- mifepristone
- mitapivat
- neratinib
- nimodipine
- nirogacestat
- nisoldipine
- olaparib
- omaveloxolone
- omeprazole
- orforglipron
- oxycodone
- palbociclib
- palovarotene
- pantoprazole
- pazopanib
- pemigatinib
- pexidartinib
- phenobarbital
- phenytoin
- pirtobrutinib
- ponatinib
- pralsetinib
- rabeprazole
- red yeast rice
- regorafenib
- relugolix
- remibrutinib
- repotrectinib
- retapamulin topical
- rifabutin
- rifampin
- rifapentine
- rilzabrutinib
- rimegepant
- ritonavir
- rivaroxaban
- ruxolitinib
- ruxolitinib topical
- salmeterol inhaled
- selumetinib
- sevabertinib
- sildenafil
- siponimod
- sirolimus albumin-bound
- sodium polystyrene sulfonate
- sonidegib
- sotalol
- sparsentan
- St. John's wort
- sufentanil
- sunitinib
- sunvozertinib
- suvorexant
- tadalafil
- tamsulosin
- tazemetostat
- temsirolimus
- thiotepa
- ticagrelor
- tipranavir
- topotecan
- trabectedin
- trazodone
- tretinoin
- turmeric
- vandetanib
- vardenafil
- verapamil
- vinblastine
- vincristine
- vinorelbine
- vonoprazan
- vorapaxar
- ziprasidone
Monitor/Modify Tx
- abemaciclib
- abiraterone acetate
- acetazolamide
- afatinib
- aficamten
- albuterol
- albuterol inhaled
- aloe
- aminophylline
- amlodipine
- amphotericin
- anagrelide
- apomorphine
- arformoterol inhaled
- aripiprazole oral
- asciminib
- asenapine
- asparaginase
- atazanavir
- atogepant
- avacopan
- avatrombopag
- azithromycin
- belumosudil
- betamethasone
- bortezomib
- brentuximab vedotin
- brexpiprazole
- bumetanide
- butorphanol
- cannabidiol
- carfilzomib
- cetuximab
- chloroquine
- chlorothiazide
- chlorthalidone
- cilostazol
- cinacalcet
- cisplatin
- citalopram
- clofazimine
- clonazepam
- clozapine
- cobicistat
- corticotropin
- cortisone
- cyclosporine
- darifenacin
- decitabine
- deflazacort
- degarelix
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- diazoxide
- dichlorphenamide
- digoxin
- diltiazem
- dinutuximab
- donepezil
- doxercalciferol
- droperidol
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- edoxaban
- elexacaftor/tezacaftor/ivacaftor
- emapalumab
- enfortumab vedotin
- epinephrine
- epirubicin
- eribulin
- eszopiclone
- ethacrynic acid
- felodipine
- flecainide
- fludrocortisone
- fluorouracil
- formoterol inhaled
- foscarnet
- fostamatinib
- furosemide
- glecaprevir
- glipizide
- goserelin
- guanfacine
- histrelin
- hydrochlorothiazide
- hydrocortisone
- hydroxyzine
- ibrexafungerp
- ibrutinib
- ibutilide
- iloperidone
- imatinib
- indapamide
- inotuzumab ozogamicin
- insulin
- isoflurane
- isoproterenol
- istradefylline
- lacosamide
- lenalidomide
- leuprolide
- levalbuterol inhaled
- levofloxacin
- levomilnacipran
- licorice
- lidocaine
- lofexidine
- loperamide
- lumateperone
- macimorelin
- magnesium citrate
- mannitol
- maraviroc
- mavacamten
- mavorixafor
- meropenem
- methazolamide
- methylprednisolone
- metoclopramide
- metolazone
- milsaperidone
- mirtazapine
- morphine
- motixafortide
- moxifloxacin
- necitumumab
- nerandomilast
- nicardipine
- nifedipine
- nintedanib
- nortriptyline
- olodaterol inhaled
- ondansetron
- osilodrostat
- osimertinib
- oxcarbazepine
- paclitaxel
- paliperidone
- palonosetron
- pamidronate
- panitumumab
- paricalcitol
- pasireotide
- pentamidine
- pibrentasvir
- pimavanserin
- polatuzumab vedotin
- polyethylene glycol
- polyethylene glycol/electrolytes
- prednisolone
- prednisone
- primidone
- probenecid
- procainamide
- quetiapine
- repaglinide
- rilpivirine
- riociguat
- rucaparib
- sacituzumab govitecan
- saxagliptin
- selinexor
- sertraline
- sevoflurane
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium thiosulfate
- solifenacin
- sulfate bowel prep
- tacrolimus
- tafasitamab
- talazoparib
- telavancin
- tenofovir alafenamide
- tenofovir disoproxil
- terbutaline
- tetrabenazine
- tezacaftor/ivacaftor
- theophylline
- tofacitinib
- tolterodine
- topiramate
- torsemide
- triamcinolone
- triclabendazole
- trifluridine
- triptorelin
- upadacitinib
- vaborbactam
- valbenazine
- vamorolone
- vanzacaftor/tezacaftor/deutivacaftor
- vilanterol inhaled
- vilazodone
- vimseltinib
- voxilaprevir
- warfarin
- zanubrutinib
- ziftomenib
- zolpidem
- zonisamide
- zuranolone
Caution Advised
- aliskiren
- alosetron
- armodafinil
- bictegravir
- budesonide inhaled
- budesonide nasal
- cannabis
- capmatinib
- chlordiazepoxide
- ciclesonide
- clindamycin
- cyclophosphamide
- darolutamide
- darunavir
- doravirine
- doxazosin
- dronabinol
- dutasteride
- elvitegravir
- eravacycline
- etravirine
- fluticasone furoate
- gefitinib
- ifosfamide
- isradipine
- mirvetuximab soravtansine
- modafinil
- mometasone implant
- mometasone inhaled
- mometasone nasal
- naldemedine
- ospemifene
- oxybutynin
- pimecrolimus topical
- ramelteon
- ripretinib
- risperidone
- roflumilast
- roflumilast topical
- seladelpar
- sirolimus topical
- tacrolimus topical
- tamoxifen
- telisotuzumab vedotin
- tinidazole
- tisotumab vedotin
- tradipitant
- venlafaxine
- zaleplon
- zileuton
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- QT prolongation
- torsades de pointes
- hepatotoxicity
- hyperbilirubinemia
- pancreatitis
- adrenal insufficiency
- pulmonary embolism
- thrombophlebitis (peripheral IV use)
- thrombocytopenia
- thrombocytopenic purpura
- hemolytic uremic syndrome
- acute renal failure
Common Reactions
- fever
- diarrhea
- nausea
- vomiting
- hypokalemia
- thrombocytopenia
- headache
- abdominal pain
- anemia
- cough
- neutropenia
- constipation
- dyspnea
- rigors
- rash
- HTN
- infection
- hypomagnesemia
- insomnia
- fatigue
- musculoskeletal pain
- edema
- anorexia
- hypotension
- epistaxis
- tachycardia
- dizziness
- hyperglycemia
- hypocalcemia
- arthralgia
- petechiae
- pseudohyperaldosteronism
- LFTs elevated
- appetite decr.
- asthenia
- mucositis
- vaginal hemorrhage
- myalgia
- weight loss
- dehydration
- diaphoresis
- hyperbilirubinemia
Safety/Monitoring .
Therapeutic Drug Levels
Invasive Fungal Infection Prophylaxis: >0.7 mcg/mL (trough); Toxic Levels: >3.75 mcg/mL (trough); Timing: trough just before the next dose; Time to Steady State: 6-10 days; Info: may not be routinely available; for use with PO suspension form, may consider for use with other forms
Invasive Fungal Infection Treatment: >1 mcg/mL (trough); Toxic Levels: >3.75 mcg/mL (trough); Timing: trough just before the next dose; Time to Steady State: 6-10 days; Info: may not be routinely available; for use with PO suspension form, may consider for use with other forms
Monitoring Parameters
Cr at baseline, then if use IV form in eGFR <50 continue frequently; electrolytes including Mg, Ca at baseline; LFTs at baseline, then during tx; K; BP
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; no human data available; risk of teratogenicity based on animal data at 1.4x recommended human dose
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for posaconazole: liver primarily; CYP450: none; UGT: 1A4 substrate
Excretion: for posaconazole: feces 71% (66% unchanged), urine 13% (<1% unchanged); Half-life: 26-35h
Subclass: Antifungals ; Candidiasis, Oropharyngeal
Mechanism of Action
for posaconazole: binds to lanosterol 14 alpha-demethylase, inhibiting ergosterol synthesis and disrupting fungal cell membrane integrity
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Merck & Co., Inc.
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
intravenous solution:
- 18 mg/mL (1 vial, 16.7 mL): $551.00
oral delayed release tablet:
- 100 mg (90 ea): $6,301.00
oral suspension:
- 200 mg/5 mL (1 bottle of oral suspension, 105 mL): $1,478.00
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