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Noxafil and Yosprala

Determining the interaction of Noxafil and Yosprala and the possibility of their joint administration.

Check result:

Noxafil <> Yosprala

Relevance: 03.09.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

The following interaction applies only if you are receiving the oral suspension of posaconazole (Noxafil), but not the other formulations: Talk to your doctor before using posaconazole together with omeprazole. By reducing stomach acid, omeprazole can decrease the absorption and blood levels of posaconazole and make the medication less effective against fungal infections. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. A temporary discontinuation of omeprazole may also be considered until you have completed treatment with posaconazole. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Coadministration with proton pump inhibitors (PPIs) may decrease the systemic bioavailability of posaconazole from the oral suspension. The proposed mechanism is reduced solubility and absorption of posaconazole due to an increase in gastric pH induced by these agents. When a single 400 mg dose of posaconazole was given to 12 healthy subjects following pretreatment with esomeprazole 40 mg once a day for 3 days, mean posaconazole peak plasma concentration (Cmax) and systemic exposure (AUC) were reduced by 46% and 32%, respectively, compared to posaconazole administered alone under fasting conditions. In the same study, coadministration of posaconazole with 12 ounces of ginger ale, an acidic beverage, increased posaconazole Cmax by 92% and AUC by 70%. When given with both esomeprazole and ginger rale together, posaconazole Cmax and AUC decreased by 33% and 21%, respectively. These data suggest that posaconazole oral bioavailability from non-delayed release formulations is at least partially dependent on gastric pH. Clinical studies in various patient cohorts receiving prophylaxis or treatment for invasive fungal infection have found PPI use to be associated with significantly reduced posaconazole plasma concentrations. The interaction was also suspected in a 58-year-old patient receiving posaconazole for invasive aspergillosis. Posaconazole serum trough level decreased significantly during coadministration with omeprazole for 3 days, but returned to baseline following discontinuation of omeprazole.

MANAGEMENT: Concomitant use of posaconazole oral suspension with proton pump inhibitors should generally be avoided. If possible, prescribers may consider suspending the PPI until completion of posaconazole therapy, or substituting an antifungal agent like fluconazole or voriconazole whose absorption is not affected by stomach pH. Delayed-release tablets of posaconazole may be used with PPIs, as no pharmacokinetic interaction has been demonstrated with esomeprazole.

References

"Product Information. Noxafil (posaconazole)." Schering-Plough Corporation, Kenilworth, NJ.
Dolton MJ, Ray JE, Chen SC, Ng K, Pont L, McLachlan AJ "Multicenter study of posaconazole therapeutic drug monitoring: exposure-response and factors affecting concentration." Antimicrob Agents Chemother 56 (2012): 5503-10
Vaes M, Hites M, Cotton F, et al. "Therapeutic drug monitoring of posaconazole in patients with acute myeloid leukemia or myelodysplasic syndrome." Antimicrob Agents Chemother 56 (2012): 6298-303
Walravens J, Brouwers J, Spriet I, Tack J, Annaert P, Augustijns P "Effect of pH and Comedication on Gastrointestinal Absorption of Posaconazole: Monitoring of Intraluminal and Plasma Drug Concentrations." Clin Pharmacokinet 50 (2011): 725-34
Shields RK, Clancy CJ, Vadnerkar A, et al "Posaconzaole serum concentrations among cardiothoracic transplant recipients: factors impacting trough levels and correlation with clinical response to therapy." Antimicrob Agents Chemother 55 (2011): 1308-11
Krishna G, Abutarif M, Xuan F, Martinho M, Angulo D, Cornely OA "Pharmacokinetics of oral posaconazole in neutropenic patients receiving chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome." Pharmacotherapy 28 (2008): 1223-32
Alffenaar JW, van Assen S, van der Werf TS, Kosterink JG, Uges DR "Omeprazole significantly reduces posaconazole serum trough level." Clin Infect Dis 48 (2009): 839
Krishna G, Moton A, Ma L, Medlock MM, McLeod J "The pharmacokinetics and absorption of posaconazole oral suspension under various gastric conditions in healthy volunteers." Antimicrob Agents Chemother 53 (2009): 958-66
Neubauer WC, Engelhardt M, Konig A, et al. "Therapeutic drug monitoring of posaconazole in hematology patients: experience with a new high-performance liquid chromatography-based method." Antimicrob Agents Chemother 54 (2010): 4029-32
Krishna G, Moton A, Ma L, Malavade D, Medlock M, McLeod J "Effect of gastric pH, dosing regimen and prandial state, food and meal timing relative to dose, and gastro-intestinal motility on absorption and pharmacokinetics of the antifungal posaconazole." 18th European Congress of Clinical Microbiology and Infectious Diseases April (2008): 20

Noxafil

Generic Name: posaconazole

Brand name: Noxafil

Synonyms: n.a.

What is Noxafil?

Yosprala

Generic Name: aspirin / omeprazole

Brand name: Yosprala

Synonyms: n.a.

What is Yosprala?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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