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Posaconazole: Brands, Price & Uses in Bangladesh
Established / FDA-Approved Uses Prophylaxis of invasive Aspergillus and Candida infections in patients at high risk due to being severely immunocompromised and more.
About Posaconazole
Indications of Posaconazole
Established / FDA-Approved Uses
- Prophylaxis of invasive Aspergillus and Candida infections in patients at high risk due to being severely immunocompromised, including hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) and patients with hematologic malignancies who have prolonged chemotherapy-induced neutropenia. Approved for adults and pediatric patients 13 years and older (oral delayed-release tablet and oral suspension); the intravenous (IV) injection is approved for this use down to 2 years of age.
- Treatment of invasive aspergillosis in adults and pediatric patients 13 years and older (IV injection formulation), typically in patients who are refractory to or intolerant of other antifungal therapy.
- Treatment of oropharyngeal candidiasis (OPC), including OPC that is refractory to itraconazole and/or fluconazole, in adults and pediatric patients 13 years and older (oral suspension formulation).
Guideline-Supported / Adjunct Uses
- Used as part of combination or salvage antifungal therapy for selected invasive fungal infections (e.g., mucormycosis) refractory to or in patients intolerant of first-line agents, based on treatment guidelines rather than a specific FDA-labeled indication for this use.
Note: Posaconazole is a broad-spectrum antifungal reserved for confirmed or high-risk invasive fungal disease and prophylaxis in defined high-risk immunocompromised populations; it is not intended for routine or minor fungal infections.
Dosage & Administration of Posaconazole
Antifungal stewardship: Take Posaconazole exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice. Completing the full prescribed course is essential to prevent treatment failure and antifungal resistance.
Delayed-Release Tablet — Prophylaxis of Invasive Fungal Infections
| Population | Loading Dose (Day 1) | Maintenance Dose |
|---|---|---|
| Adults and pediatric patients ≥13 years | 300 mg twice daily | 300 mg once daily, starting Day 2; duration based on recovery from neutropenia or immunosuppression |
Swallow tablets whole with a full glass of water; do not split, crush, or chew. May be taken with or without food.
Oral Suspension
| Indication | Dose |
|---|---|
| Prophylaxis of invasive fungal infections (adults, ≥13 years) | 200 mg (5 mL) three times daily |
| Oropharyngeal candidiasis (OPC) | 100 mg twice daily on Day 1, then 100 mg once daily for 13 more days |
| OPC refractory to itraconazole/fluconazole | 400 mg (10 mL) twice daily; duration based on severity and response |
Take with a full meal or liquid nutritional supplement to maximize absorption; shake suspension well before each dose.
Intravenous Injection
| Indication | Loading Dose (Day 1) | Maintenance Dose |
|---|---|---|
| Treatment of invasive aspergillosis (adults/peds ≥13 years) | 300 mg IV twice daily | 300 mg IV once daily; typical duration 6–12 weeks depending on response |
| Prophylaxis (adults and pediatrics ≥2 years, weight ≤40 kg) | 6 mg/kg (max 300 mg) twice daily | 6 mg/kg (max 300 mg) once daily |
Administer by slow intravenous infusion over approximately 90 minutes through a central venous line and an in-line filter. Do not give as an IV bolus. A peripheral line may be used only for a single dose before central line placement.
Renal and Hepatic Adjustment
- Renal impairment: No dosage adjustment is needed for oral formulations. The IV injection should generally be avoided in patients with moderate-to-severe renal impairment (eGFR <50 mL/min) because its vehicle can accumulate; oral therapy is preferred if renal function is impaired.
- Hepatic impairment: No initial dose adjustment is established as necessary for mild-to-severe hepatic impairment, but liver function should be monitored closely and Posaconazole discontinued if signs of liver disease develop (see Precautions and Warnings).
Side Effects of Posaconazole
Common Side Effects
- Diarrhea, nausea, vomiting, abdominal pain, constipation
- Fever
- Headache
- Rash
- Peripheral edema, cough
- Low potassium (hypokalemia) or low magnesium (hypomagnesemia)
- Anemia, low platelet count (thrombocytopenia)
Serious Side Effects (Seek Medical Attention)
- Signs of liver problems: yellowing of skin/eyes, dark urine, severe fatigue, right upper abdominal pain (see Precautions and Warnings for hepatotoxicity monitoring).
- Irregular heartbeat, palpitations, or fainting, which may indicate QT prolongation or torsades de pointes.
- Signs of a severe allergic reaction: swelling of the face/throat, difficulty breathing, severe rash.
- Unusually high blood pressure with low potassium (pseudoaldosteronism), reported rarely.
Contraindications of Posaconazole
Posaconazole is contraindicated in the following situations:
- Known hypersensitivity to Posaconazole or to any other azole antifungal agent.
- Concomitant use with sirolimus (markedly increases sirolimus levels and toxicity risk).
- Concomitant use with pimozide or quinidine (risk of QT prolongation and torsades de pointes).
- Concomitant use with CYP3A4-metabolized statins such as simvastatin, lovastatin, or atorvastatin (increased risk of rhabdomyolysis).
- Concomitant use with ergot alkaloids (ergotamine, dihydroergotamine) — risk of ergotism.
- Concomitant use with venetoclax at initiation and during the dose ramp-up phase in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
Frequently Asked Questions about Posaconazole
What is Posaconazole used for?
Posaconazole is a triazole antifungal medicine used to prevent invasive fungal infections (such as those caused by Aspergillus and Candida) in people with severely weakened immune systems, and to treat certain invasive fungal infections and oral/throat thrush (oropharyngeal candidiasis), including cases that have not responded to other antifungal medicines.
Can I switch between the Posaconazole tablet, suspension, and injection?
No. The different Posaconazole formulations are absorbed differently and are not interchangeable at the same dose. Only switch formulations if your physician specifically instructs you to and adjusts the dose accordingly.
Are there foods or medicines I should avoid while taking Posaconazole?
Posaconazole oral suspension should be taken with food to absorb properly. Posaconazole interacts significantly with many medicines processed by the liver, including certain immunosuppressants (like tacrolimus, cyclosporine, and sirolimus), certain statins, ergot medicines, some heart rhythm medicines, and some sedatives. Posaconazole is contraindicated with sirolimus, pimozide, quinidine, simvastatin/lovastatin/atorvastatin, ergot alkaloids, and (during initiation) venetoclax in certain leukemias. Tell your doctor about all medicines you take before starting Posaconazole.
What monitoring will I need while on Posaconazole?
Your doctor will likely check your liver function tests periodically, and may check your heart rhythm (ECG) and blood electrolytes (potassium, magnesium), because Posaconazole can affect the liver and can prolong the QT interval, increasing the risk of an abnormal heart rhythm.
Is Posaconazole safe during pregnancy or breastfeeding?
Posaconazole may cause harm to a developing baby based on animal studies, so it should be used in pregnancy only if clearly needed and the benefit outweighs the risk, as decided with your physician. It is not known if Posaconazole passes into breast milk, so breastfeeding decisions should also be made with your doctor's guidance.
What should I do if I miss a dose or think I have taken too much Posaconazole?
If you miss a dose, take it as soon as you remember unless it is nearly time for the next dose — do not double up. If you suspect an overdose of Posaconazole, seek immediate medical attention or contact a poison control center right away, as this requires prompt medical evaluation.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.