Noxafil (Posaconazole) - Oral

What Is Noxafil?

Noxafil (posaconazole) is a prescription medication used to prevent systemic (bloodstream) Aspergillus and Candida fungal infections. Noxafil is categorized as a second-generation triazole antifungal.

As an azole antifungal, specifically a triazole type of azole antifungal, Noxafil works by blocking a specific fungal protein called cytochrome P-450-mediated 14 alpha-lanosterol demethylase enzyme. This protein is responsible for turning lanosterol—a type of steroid—into ergosterol. Without ergosterol, the weakened fungal cell wall starts to fall apart.

The delayed-release (DR) tablets can be used to prevent these infections in people at least 2 years old and weighing at least 88 pounds. The liquid version, however, can only be used by people 13 and older.

People 13 and older may also use the DR tablets to treat systemic Aspergillus fungal infections and the liquid suspension version to treat thrush (an oral Candida infection).

Aside from the oral dosage forms that this article will focus on, Noxafil, both as a brand name and as a generic product (posaconazole), is also available as an intravenous (IV; into the vein) infusion.

What Is Noxafil Used For?

The Food and Drug Administration (FDA) approved Noxafil as a medication to prevent or treat the following systemic fungal infections:

• Aspergillosis: The Aspergillus mold (type of fungus) is responsible for Aspergillosis infections. The Aspergillus mold is common. You can find it indoors or outside. Many people breathe in Aspergillus spores without any issues. These spores may cause health problems, however, in people with a weakened immune system (the body's defense system) or lung conditions.
• Candidiasis: The Candida yeast (type of fungus) is responsible for Candidiasis infections. The Candida yeast naturally lives inside or on your body without causing any issues. This yeast, however, may cause health problems in certain high-risk people, such as individuals with a weakened immune system.

Additionally, the DR tablets may also be used to treat systemic Aspergillus fungal infections, while the liquid suspension version is an option used to treat thrush from a Candida yeast infection.

How to Take Noxafil

While Noxafil is available in multiple dosage forms, they're not interchangeable. Talk with your healthcare provider if you have concerns about switching between products. They can also help you with questions about how to take your medications.

The following, however, is some general information about Noxafil DR use:

• Take DR tablets with or without food.
• Swallow whole DR tablets. Don't chew, crush, or split tablets.
• Take DR tablets by mouth twice daily on the first day of therapy.
• Starting on the second day of therapy, take DR tablets by mouth once daily.
• To prevent systemic (bloodstream) Aspergillus and Candida fungal infections, you'll likely take the DR tablets for as long as you have a weakened immune system (the body's defense system).
• To treat systemic Aspergillus fungal infections, you'll likely take the DR tablets for six to 12 weeks.

The liquid suspension version of Noxafil also has the following information to keep in mind:

• Shake the Noxafil liquid to mix this medication before each use.
• Make sure to use the spoon that came with your medication to measure your Noxafil liquid doses.
• Take liquid Noxafil with a full meal. Alternatives to a full meal may also include a nutritional supplement or an acidic carbonated drink (e.g., ginger ale).
• To prevent systemic Aspergillus and Candida fungal infections, you'll likely take the Noxafil liquid by mouth three times daily for as long as you have a weakened immune system.
• To treat thrush from an oral (by mouth) Candida infection, you'll take the Noxafil liquid by mouth twice daily on the first day of therapy. Then, you'll take the liquid version once daily for the next 13 days.
• To treat thrush that didn't go away with other antifungals (e.g., itraconazole, fluconazole, or both), you'll take the Noxafil liquid by mouth twice daily for as long as necessary. The duration will depend on how severe your infection is.
  

Storage

When you receive Noxafil from the pharmacy, keep the liquid version at 77 degrees F and the DR tablets between 68 to 77 degrees. So, room temperature should be sufficient. However, dosage forms also have a short-term safety storage range between 59 to 86 degrees.

Make sure to not freeze the Noxafil liquid suspension. Also, keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet. Do not store your medication in the bathroom.

Try to avoid pouring unused and expired drugs down the drain or in the toilet. Visit the FDA's website to know where and how to discard all unused and expired drugs. You can also find disposal boxes in your area. Ask your pharmacist or healthcare provider if you have any questions about the best ways to dispose of your medications.

If you plan to travel with Noxafil, get familiar with your final destination's regulations. Checking with the U.S. embassy or consulate might be a helpful resource. In general, however, make a copy of your Noxafil prescription. It's also a good idea to keep your medication in its original container from your pharmacy with your name on the label.

If you have any questions about traveling with your medicine, be sure to ask your pharmacist or healthcare provider.

Off-Label Uses

You may see healthcare providers prescribe Noxafil (posaconazole) for some of the following off-label uses:

• Aspergillosis: The FDA hasn't approved Noxafil liquid for the treatment of aspergillosis. Experts, however, support Noxafil liquid suspension in the treatment of systemic Aspergillus fungal infections. Experts also support Noxafil liquid to treat an Aspergillus fungal infection of the lung called chronic cavitary pulmonary aspergillosis.
• Coccidioidomycosis (Valley fever) when other antifungals didn't help: The Coccidioides fungus is responsible for Valley fever infections. You can find this fungus in the soil of the southwestern U.S. You may also find this fungus in certain parts of Mexico, Central America, and South America. The fungus may enter your body if you breathe in a lot of dust in these areas. There are also reports of Valley fever in people with human immunodeficiency virus (HIV). Experts support the use of the Noxafil DR tablet or liquid suspension version for Valley fever in people with HIV when other antifungals—like fluconazole or itraconazole—don't help.
• Mucormycosis (zygomycosis) when other medications didn't help: The mucormycete mold (group of fungi) is responsible for mucormycosis, which is a rare but serious fungal infection. You can find these molds in soil, dead leaves, or rotten wood. People with a weakened immune system (the body's defense system) may get this infection by breathing in these molds. Experts support Noxafil for mucormycosis when other medications didn't help. In fact, experts tend to prefer tablets over the liquid suspension version.
  

What Are the Side Effects of Noxafil?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Noxafil in adults may include:

• Cough
• Diarrhea
• Fever
• Headache
• Low potassium levels, with symptoms of twitchy weak muscles or a tingling numb sensation
• Nausea or vomiting

Common side effects of Noxafil that children might experience may include:

• Fever with or without low white blood cell (WBC) count
• High blood pressure
• Low potassium levels
• Itchiness
• Red sores on the lips and genitals (e.g., vagina, penis)
• Red sores in the mouth, throat, or stomach lining
• Vomiting
  

Severe Side Effects

Get medical help right away if you experience the following serious side effects:

• Severe allergic reaction with symptoms of itchiness, swelling, breathing difficulties
• Abnormal heart rhythm with symptoms of fast or irregular heartbeat
• Breakthrough fungal infections with symptoms of serious diarrhea or vomiting
• Electrolyte (e.g., sodium) imbalances
• Liver problems with symptoms of yellow eyes or skin

Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

Long-term use of Noxafil may result in long-term side effects that are similar to its common and serious side effects. This may include:

• Electrolyte imbalances
• Hypertension (high blood pressure)

Adjusting Noxafil's dose or stopping the medication may reverse these side effects.

Dosage: How Much Noxafil Should I Take?

Modifications

The following modifications (changes) should be kept in mind when using Noxafil:

Severe allergic reaction: Avoid using Noxafil if you have a known allergy to it or any of its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In rat and rabbit animal studies, posaconazole was found to have negative effects on the fetus. We don't know enough about the safety and effectiveness of Noxafil in pregnant people and on the unborn fetus.

Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of Noxafil during your pregnancy.

Breastfeeding: Posaconazole is present in rat breast milk. So, this medication is likely to be present in human breast milk, but we don't know enough about the safety and effects of Noxafil in human breast milk and nursing babies.

Talk with your healthcare provider if you plan to breastfeed. They can help you weigh the benefits and harms of Noxafil while nursing. They can also discuss the different ways to feed your baby.

Older adults over 65: There were no differences in response to Noxafil between older and younger adults. However, older adults with several medical conditions or taking several medications should use caution. In addition, older adults might be more sensitive to side effects from medications.

Children: The FDA approved Noxafil DR tablets to prevent systemic Aspergillus and Candida fungal infections in people with a minimum age of 2 years old and a weight of more than 88 pounds. The DR tablets can also be used to treat systemic Aspergillus fungal infections in children 13 years and older.

The Noxafil liquid, on the other hand, is FDA-approved for people 13 years and older. The liquid version can be used to prevent systemic Aspergillus and Candida fungal infections. It can also be used to treat thrush.

Kidney problems: Individuals with kidney problems may not be able to clear the medication from their bodies as easily. This means the medicine stays in the body longer and can have increased side effects. For this reason, if you have any degree of kidney impairment, your healthcare provider will closely monitor you for high Noxafil levels and more side effects.

Weight over 264 pounds: Noxafil levels might be lower in people weighing over 264 pounds. These lower levels might mean reduced Noxafil effectiveness, resulting in a higher chance of breakthrough fungal infections. Therefore, your healthcare provider will closely monitor for these infections.

Missed Dose

If you accidentally forgot your Noxafil dose, take it as soon as you remember. Skip the missed dose, however, if it's already close to your next scheduled dosing time—specifically within 12 hours of your next dose for the Noxafil DR tablets or liquid suspension.

Instead, take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Try to find ways that work for you to help yourself remember to routinely keep your appointments and take your medication. If you miss too many doses, Noxafil might be less effective.

Overdose: What Happens If I Take Too Much Noxafil?

There is limited information available about Noxafil overdoses. There was one report, however, of someone experiencing no side effects after accidentally taking a high dose of 1200 milligrams twice daily for three days of DR tablets.

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Noxafil?

Before using Noxafil, talk with your healthcare provider if any of the following applies to you:

Severe allergic reaction: If you have a severe allergic reaction to Noxafil or any of its components (ingredients), then this medication isn't a viable option for you.

Pregnancy: We don't know enough about the safety and effectiveness of Noxafil in pregnant people and on the unborn fetus. Discuss with your healthcare provider to weigh the benefits and risks of Noxafil during your pregnancy.

Breastfeeding: We don't know enough about the safety and effects of Noxafil in human breast milk and nursing babies. Talk with your healthcare provider to weigh the benefits and harms of Noxafil while breastfeeding.

Older adults over 65: There were no differences in response to Noxafil between older and younger adults. In general, however, older adults should use caution.

Children: The FDA approved Noxafil for use in children. Children 13 years and older can use either the Noxafil DRtablets or the liquid suspension version.

Younger children with a minimum age of 2 must also weigh more than 88 pounds to take Noxafil by mouth. These young children will only be able to take the DR tablets to prevent systemic Aspergillus and Candida fungal infections.

Certain medications: Noxfil shouldn't be taken with numerous medications.

What Other Medications May Interact With Noxafil?

In general, Noxafil has many drug interactions. The following are some key ones:

Certain medications that cause abnormal heart rhythm: Noxafil may raise your risk of abnormal heart rhythm. This risk is further increased with medicines that may have the same side effect—especially if Noxafil also slows down the breakdown of these medications. For this reason, avoid combining Noxafil with the following medications, such as Multaq (dronedarone) and Ranexa (ranolazine).

Certain statins: Statins are typically used for high cholesterol. Combining Noxafil with certain statins—like Zocor (simvastatin)—raises your risk of severe muscle-related side effects. For this reason, this combination should be avoided.

Ergotamine medications: Ergotamines are medications used for migraine relief. Noxafil may raise ergotamine levels and increase your chances of severe side effects, such as dangerously low blood flow to your brain. Avoid combining these medications.

Sirolimus: Sirolimus is a medication option used for a number of medical conditions, such as preventing organ transplant rejection. It works by suppressing your immune system (the body's defense system). Combining Noxafil with sirolimus might result in a build-up of sirolimus in the body, leading to more side effects.

Venclexta (ventoclax): Venclexta is a medication used for several blood cancers, such as chronic lymphocytic leukemia (CLL) or acute myeloid leukemia (AML). Noxafil shouldn't be used when you're starting Venclexta or increasing the Venclexta dose. This is to prevent Venclexta-related side effects, such as tumor lysis syndrome. This is a life-threatening condition when too many cancer cells die at the same time and release all of their contents into your bloodstream.

For more detailed information about medication interactions with Noxafil, talk with your healthcare provider.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC), nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Noxafil is an azole antifungal, specifically a triazole type of azole antifungal.

The following are other second-generation triazole antifungals that also have oral (by mouth) and intravenous (into the vein) dosage forms:

• Cresemba (isavuconazonium sulfate)
• Vfend (voriconazole)

While these triazoles have similar dosage forms, they do have the following differences in what they can do.

Cresemba: Cresemba can only be used to treat systemic (bloodstream) aspergillosis and mucormycosis fungal infections in adults.

Vfend: Vfend has several uses for people 2 years and older. In fact, it can be used to treat systemic aspergillosis, candidiasis (yeast), scedosporiosis, and fusariosis fungal infections. It can also treat candidiasis infection of the throat (thrush).

Noxafil: As for Noxafil, it's a little bit more complicated on what it can do. Similar to Cresemba, or Vfend, the FDA approved Noxafil to treat systemic aspergillosis—but only the DR tablets and injection dosage forms can do this in people 13 years and older. Like Vfend, Noxafil is also FDA-approved to treat thrush—but only the liquid version can do this in people 13 years and older.

Noxafil is unique because of its FDA approval for the prevention of systemic aspergillosis and candidiasis fungal infections. The DR tablets and the injection can do this in people 2 years and older.

To use the DR tablets for this, however, your child must weigh more than 88 pounds. If your child weighs less than 88 pounds, they will need to use the Noxafil injection to prevent these systemic fungal infections. The liquid version can also help prevent these infections—but only in people 13 years and older.

Aside from FDA-approved uses, these three triazoles also have the following different advantages and side effects:

Cresemba: Cresemba is a long-acting and broad-spectrum antifungal. Broad-spectrum means that this medication can target a lot of different fungi. It's also quickly absorbed into the bloodstream and has few medication interactions. Side effects, however, may include diarrhea, dizziness, flu-like symptoms, and stomach pain. Some people may also experience red, itchy, and watery eyes.

Vfend: Similar to Cresemba, Vfend is also a broad-spectrum antifungal that's quickly absorbed into the bloodstream. Side effects with Vfend, however, may include vision changes, swelling of the face or lips, and life-threatening skin reactions.

Noxafil: Noxafil is also considered a broad-spectrum antifungal. Compared to Cresemba and Vfend, however, Noxafil doesn't absorb into your bloodstream as well. It may also be more costly with a higher likelihood of side effects, which may include diarrhea and nausea.

Since all of these medications are broad-spectrum triazole antifungals, they're not typically used together.

How Can I Stay Healthy While Taking Noxafil?

If you're taking Noxafil, chances are you might be worried about certain fungal infections. Preventing or treating fungal infections does have its challenges. You may have tried different approaches or medications.

Refer below for some general tips to support your health.

There are also some recommendations to prevent these fungal infections, such as:

• Take medications as recommended by your healthcare provider.
• Try to avoid places with a lot of dust to prevent aspergillosis. If you can't avoid these areas, consider wearing an N95 mask.
• Try to limit gardening and similar activities where you're likely going to be close to dirt or dust that may have aspergillosis spores. If you can't avoid these activities, consider wearing gloves, long-sleeve shirts, long pants, and shoes.
• Use soap and water to clean your hands and skin injuries to decrease your chances of getting fungal infections.
• Try to keep your mouth and teeth clean with good oral (by mouth) hygiene or habits to prevent thrush.
• Rinse your mouth after using inhalers that have corticosteroids (steroids), such as Advair Diskus or AirDuo.