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Overview: Posaconazole is used to treat or prevent fungal infections. It stops fungus from growing. Common side effects include nausea, vomiting, diarrhea, and headache. Serious side effects are rare, but can include liver problems. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat. Posaconazole comes as a tablet, liquid, powder that is mixed into liquid, and injection.

Uses

What is posaconazole used for?

Posaconazole is commonly used to treat or prevent the following fungal infections.

  • Aspergillosis, which is an infection that may affect the lungs or other parts of the body
  • Invasive candidiasis in your blood or throughout your body
  • Oropharyngeal candidiasis, which is an infection of the mouth and throat (sometimes called oral thrush)

Posaconazole may not be appropriate for some of the infections listed above, depending on which germs are causing the infection. Fungi in some locations may have developed resistance to posaconazole, which will make it not work as well.

Posaconazole may also be used for other conditions as determined by your healthcare provider.

How does posaconazole work (mechanism of action)?

Posaconazole is an antifungal medicine that works by stopping the fungal growth causing the infection.

How is posaconazole supplied (dosage forms)?

Brand and other names

  • Noxafil
  • Noxafil PowderMix

Dosage forms and strengths

  • 100 mg delayed-release oral tablets
  • 300 mg delayed-release powder for oral suspension
  • 40 mg/mL oral suspension

Posaconazole is also available in injectable forms.

How should I store posaconazole?

Oral Tablet, Liquid, or Powder. Posaconazole tablet, liquid, or powder that is mixed into liquid (Noxafil PowderMix) should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not freeze posaconazole oral liquid. If you are prescribed posaconazole powder, do not open the foil packet containing the powder until you are ready to use it. 

Injection Liquid. Posaconazole injection is usually given by a healthcare provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of posaconazole?

The most common side effects of posaconazole are listed below. Side effects may vary based on age. Tell your healthcare provider if you have any of these side effects that bother you.

There may be other side effects of posaconazole that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of posaconazole?

While less common, the most serious side effects of posaconazole are described below, along with what to do if they happen.

Severe Allergic Reactions. Posaconazole may cause allergic reactions, which can be serious. Stop using posaconazole and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Rhythm Changes. Posaconazole may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take some medicines for other heart rhythm problems. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when using posaconazole. This can be serious or life-threatening. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Diarrhea or Vomiting. Diarrhea and vomiting are common with posaconazole. These can be severe in some cases. If that happens, your body may not be able to absorb enough posaconazole for it to work well. Tell your healthcare provider right away if you have severe diarrhea or vomiting.

Electrolyte Changes. Posaconazole may cause changes to the levels of certain minerals in your body, called electrolytes. For example, it may cause low potassium levels (hypokalemia), low magnesium levels (hypomagnesemia), or changes in calcium levels. These changes can be serious. Keep appointments for blood work so that your healthcare provider can check your electrolyte levels, especially if you take certain other medicines. 

Warnings & Precautions

Who should not use posaconazole?

Allergies to Ingredients. People who are allergic to any of the following should not use posaconazole.

  • Posaconazole
  • Noxafil
  • Noxafil PowderMix
  • Any other medicine known as an azole antifungal, such as fluconazole, itraconazole, ketoconazole, or voriconazole
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific posaconazole products they stock.

Drug Interactions. Posaconazole should not be used while you are using certain other medicines. Before using posaconazole, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Hereditary Fructose Intolerance. Posaconazole powder that is mixed into liquid (Noxafil PowderMix) should not be taken if you have a condition that affects your ability to digest the sugar, fructose. This condition is known as hereditary fructose intolerance. 

What should I know about posaconazole before using it?

Do not use posaconazole unless it has been prescribed to you by a healthcare provider. Use it as prescribed.

Do not share posaconazole with other people, even if they have the same condition as you. It may harm them.

Keep posaconazole out of the reach of children.

There are several forms of posaconazole available and they may be used to treat or prevent different conditions. They may also have different dosages. You should not switch between forms of posaconazole without talking to your healthcare provider. Ask your healthcare provider if you are not sure how to take the posaconazole form you are prescribed. 

If you are prescribed posaconazole oral liquid, shake it well before each dose. Use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.

If you are prescribed posaconazole tablets, you should swallow them whole. Do not cut, break, or chew them.

Read and follow the “Instructions for Use” to prepare and take posaconazole powder that is mixed into liquid (Noxafil PowderMix). Doses should only be made and taken with the syringe provided with it. Make sure to take the dose of medicine within one hour of mixing it.

Keep all appointments for bloodwork while you are taking posaconazole.

What should I tell my healthcare provider before using posaconazole?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if posaconazole is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • A weakened immune system, including HIV or AIDS
  • Liver or kidney problems
  • Heart problems, including heart rhythm problems
  • Blood flow or circulation problems

Pregnancy. It is not known if or how posaconazole could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.

Breastfeeding. It is not known if posaconazole passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop posaconazole.

Interactions

Does posaconazole interact with foods or drinks?

Posaconazole tablets may be taken with or without food. 

Posaconazole oral liquid should be taken with or within 20 minutes of a full meal. If you are not able to eat a full meal, you can take it with a liquid nutritional supplement or a carbonated drink, such as ginger ale. 

Posaconazole powder that is mixed into liquid (Noxafil PowderMix) should be taken with food. This form of posaconazole should not be taken with alcohol. Alcohol can change how the medicine is released into your body, which can increase side effects and affect how it works. 

It is unknown if drinking alcohol will affect posaconazole tablets, liquid, or injection, but heavy drinking can slow your immune response and make it harder for your body to fight infection.  

Does posaconazole interact with other medicines (drug interactions)?

Posaconazole interacts with many other medicines. Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using posaconazole.

  • Sirolimus (Rapamune), tacrolimus (Prograf and others), or cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine that suppresses your immune system
  • Medicines that can cause QT prolongation, which is a potentially dangerous heart rhythm problem, such as pimozide or quinidine
  • A statin, such as atorvastatin (Lipitor and others), lovastatin, simvastatin, or rosuvastatin (Crestor), which is a medicine to lower cholesterol
  • An ergot, such as ergotamine (Ergomar) or dihydroergotamine (Migranal or Trudhesa), which is a medicine used to treat migraine
  • Venetoclax (Venclexta), vincristine, or vinblastine, which is a medicine used to treat certain cancers
  • Rifabutin (Mycobutin), which is a medicine used to prevent Mycobacterium avium complex infection
  • Phenytoin (Dilantin, Phenytek, and others), which is a medicine to control seizures
  • Efavirenz, ritonavir, atazanavir, or fosamprenavir, which is a medicine commonly used for HIV
  • Cimetidine (Tagamet HB), which is a medicine used for heartburn
  • A proton pump inhibitor (PPI), such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex)
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Metoclopramide (Reglan and others), which is a medicine for certain stomach problems
  • A benzodiazepine, such as clonazepam (Klonopin), diazepam (Valium and others), midazolam, or lorazepam (Ativan and others), which is a medicine used for anxiety, muscle spasms, or seizures
  • Diltiazem, verapamil, nifedipine, nicardipine, or felodipine, which is a medicine used for high blood pressure and other conditions
  • Glipizide, which is a medicine for type 2 diabetes

Many other medicines may alter the blood levels of posaconazole, and vice versa. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with posaconazole. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much posaconazole?

If you or someone else has used too much posaconazole, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of posaconazole?

It is important to complete your prescribed course of posaconazole, even if your symptoms get better or go away. This will reduce the risk that future infections are resistant to posaconazole or other similar medicines.

Oral Tablet. If you miss a dose of the posaconazole tablet, take it as soon as you remember. If you do not remember until it is within 12 hours of the next dose, you should skip the missed dose and go back to the regular schedule. Do not take double or extra doses.

Oral Liquid or Powder. If you miss a dose of posaconazole liquid or powder that is mixed into liquid (Noxafil PowderMix), you should take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and go back to the regular schedule. Do not take double or extra doses.

Injection Liquid. Posaconazole injection is usually given by a healthcare provider in a hospital or clinic. Your healthcare provider will make sure you are receiving ceftriaxone as scheduled.