Fungal infections:

Indications for: NOXAFIL

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.

Adult Dosage:

Swallow whole. Take with food. ≥13yrs: 300mg twice a day on Day 1, then 300mg once daily starting on Day 2 until recovery from neutropenia or immunosuppression.

Children Dosage:

<13yrs: not established.

NOXAFIL Contraindications:

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).

NOXAFIL Warnings/Precautions:

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.

NOXAFIL Classification:

Azole antifungal.

NOXAFIL Interactions:

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.

Adverse Reactions:

Fever, diarrhea, nausea, vomiting, headache, hypokalemia, cough; lab abnormalities (eg, anemia, neutropenia, thrombocytopenia, increased liver enzymes), arrhythmias, QT prolongation.

Metabolism:

Hepatic (CYP3A4).

Drug Elimination:

Fecal (major), renal.

Generic Drug Availability:

NO

How Supplied:

Tabs—60; Susp—105mL (w. dosing spoon); Vials—1

Pricing for NOXAFIL

100mg tablet (Qty: 90)
Appx. price $1855
GoodRx