Noxafil Intravenous and Proferrin-ES

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.

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 raNITIdine. By reducing stomach acid, raNITIdine 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 raNITIdine 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.

GENERALLY AVOID: Coadministration with H2-receptor antagonists 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. In healthy volunteers, posaconazole mean peak plasma concentration (Cmax) and systemic exposure (AUC) were each reduced by 39% during coadministration of posaconazole 200 mg once a day with cimetidine 400 mg twice a day for 10 days. Based on this and other data reported in the literature, particularly with proton pump inhibitors, it appears likely that posaconazole oral bioavailability from non-delayed release formulations is at least partially dependent on gastric pH. However, the product labeling states that no clinically relevant effects on posaconazole bioavailability, efficacy, or safety were observed when the oral suspension is administered with an H2 antagonist other than cimetidine, and no particular precaution is recommended during concomitant use except with cimetidine. Several published studies investigating the factors affecting posaconazole plasma concentrations in various patient cohorts found no association with ranitidine exposure, and a pharmacokinetic subanalysis conducted in a pivotal phase 3 clinical trial also reported no effect of H2 antagonists on posaconazole concentration, while a study from Australia identified ranitidine use as a significant factor in reduced posaconazole concentrations in a multiple linear regression analysis. The reason for this discrepancy has not been established.

MANAGEMENT: Concomitant use of posaconazole oral suspension with cimetidine should generally be avoided. Until more information is available, this precaution should also be considered for other H2-receptor antagonists, although the manufacturer suggests otherwise. If possible, prescribers may consider suspending the H2 antagonist 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 H2 antagonists, as no pharmacokinetic interaction has been demonstrated with ranitidine or other agents affecting gastric pH such as proton pump inhibitors or antacids.

Noxafil Intravenous

Generic Name: posaconazole

Brand name: Noxafil

Synonyms: Noxafil

What is Noxafil Intravenous?

Proferrin-ES

Generic Name: heme iron polypeptide

Brand name: Proferrin-ES, Baciguent, Probiotic Formula

Synonyms: n.a.

What is Proferrin-ES?