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.

Drug Facts

Generic Name: Posaconazole

Brand Name(s): Noxafil

Drug Availability: Prescription

Therapeutic Classification: Second-generation triazole antifungal

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Posaconazole

Dosage Form(s): DR tablet, liquid solution

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.

How Long Does Noxafil Take to Work?

How long Noxafil takes to work depends on the type of fungal infection.

If you're taking Noxafil DR tablets to treat systemic Aspergillus fungal infections, the duration of treatment is at least six weeks.

If you're taking Noxafil liquid to treat thrush, you may notice an improvement in your symptoms after 14 days of therapy. However, if you're taking the Noxafil liquid for thrush when other antifungals didn't help, the duration of treatment might take at least 28 days.

For the prevention of systemic Aspergillus and Candida fungal infections, Noxafil was able to prevent these infections and death—at least as well as fluconazole or itraconazole antifungals for at least 100 days to 112 days (16 weeks).

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:

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

Severe Side Effects

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

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:

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

Report Side Effects

Noxafil may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Noxafil Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For prevention of fungus infections:
    • For oral dosage form (delayed-release tablets):
      • Adults and children 2 years of age and older weighing more than 40 kilograms (kg)—300 milligrams (mg) (three 100 mg delayed-release tablets) 2 times a day on the first day, then 300 mg once a day.
      • Children younger than 2 years of age or weighing 40 kg or less—Use and dose must be determined by your doctor.
    • For oral dosage form (suspension):
      • Adults and children 13 years of age and older—200 milligrams (mg) or 5 milliliters (mL) 3 times a day.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.
    • For oral dosage form (delayed-release suspension):
      • Adults and children 2 years of age and older—Dose is based on body weight and must be determined by your doctor.
        • Weighing 36 to 40 kilograms (kg)—240 milligrams (mg) or 8 milliliters (mL) 2 times a day on the first day, then 240 mg or 8 mL once a day.
        • Weighing 26 to less than 36 kg—210 mg or 7 mL 2 times a day on the first day, then 210 mg or 7 mL once a day.
        • Weighing 21 to less than 26 kg—180 mg or 6 mL 2 times a day on the first day, then 180 mg or 6 mL once a day.
        • Weighing 17 to less than 21 kg—150 mg or 5 mL 2 times a day on the first day, then 150 mg or 5 mL once a day.
        • Weighing 12 to less than 17 kg—120 mg or 4 mL 2 times a day on the first day, then 120 mg or 4 mL once a day.
        • Weighing 10 to less than 12 kg—90 mg or 3 mL 2 times a day on the first day, then 90 mg or 3 mL once a day.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
  • For treatment of invasive aspergillosis:
    • For oral dosage form (delayed-release tablets):
      • Adults and children 13 years of age and older—300 milligrams (mg) (three 100 mg delayed-release tablets) 2 times a day on the first day, then 300 mg once a day for 6 to 12 weeks.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.
  • For initial treatment of oral candidiasis:
    • For oral dosage form (suspension):
      • Adults and children 13 years of age and older—100 milligrams (mg) or 2.5 milliliters (mL) 2 times a day on the first day, then 100 mg or 2.5 mL once a day for 13 days.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.
  • For treatment of oral candidiasis after failed treatment with itraconazole or fluconazole:
    • For oral dosage form (suspension):
      • Adults and children 13 years of age and older—400 milligrams (mg) or 10 milliliters (mL) 2 times a day.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.

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.

What Happens If I Overdose on Noxafil?

If you think you or someone else may have overdosed on Noxafil, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Noxafil, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests will be needed to check for unwanted effects.

You should not use atorvastatin (Lipitor®), lovastatin (Mevacor®), pimozide (Orap®), quinidine (Quinaglute®), simvastatin (Zocor®), sirolimus (Rapamune®), or ergotamine medicines (eg, bromocriptine, dihydroergotamine, ergonovine, ergotamine, methylergonovine, methysergide, Cafergot®, Ergomar®, Wigraine®). Using any of them together with this medicine may increase the chance of unwanted effects.

This medicine can cause changes in heart rhythms, including QT prolongation and torsades de pointes. Check with your doctor right away if you have chest pain or discomfort, fainting, irregular or slow heart rate, or trouble breathing.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow skin or eyes. These could be symptoms of a serious liver problem.

Check with your doctor right away if you have severe diarrhea or vomiting while using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

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.

Frequently Asked Questions

  • Where is Noxafil available?

    Noxafil is available as a prescription from your healthcare provider. Your local retail pharmacy may carry this medication. If your pharmacy doesn't have Noxafil in stock, they might be able to order it for you.

  • How much does Noxafil cost?

    The FDA may have approved generic versions for certain Noxafil dosage forms. These generic products, however, may not be available yet. So, Noxafil might be costly without insurance.

    If cost is a concern. Noxafil's manufacturer does offer a patient assistance program. You can also ask your healthcare provider for more information on financial support programs.

  • How long do I need to take Noxafil?

    How long you take Noxafil will depend on what fungal infection you're treating or preventing. In general, the duration of therapy may vary between two weeks to 16 weeks.

    Since the length of therapy may vary per person, talk with your healthcare provider for recommendations on how long you should take Noxafil.

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.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Ross Phan, PharmD, BCACP, BCGP, BCPS
Ross is a writer for Verywell with years of experience practicing pharmacy in various settings. She is also a board-certified clinical pharmacist and the founder of Off Script Consults.