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The following information outlines crucial safety warnings and precautions associated with the use of posaconazole (Noxafil). It is important to carefully understand these details and discuss any concerns with your healthcare professional.

• Effectiveness Concerns: Severe diarrhea or vomiting may indicate that posaconazole is not effectively treating your fungal infection. Seek medical attention immediately if these symptoms occur.

• Liver Health: Posaconazole has the potential to cause liver damage, often without symptoms. Regular blood tests may be recommended to monitor liver enzyme levels. Be alert for symptoms such as unexplained stomach pain, nausea, vomiting, dark urine, pale stools, or yellowing of the skin or eyes, and seek medical help if they occur. Individuals with a history of liver problems are at increased risk.

• Heart Rhythm Issues: This medication can lead to a condition known as QT prolongation, a heart rhythm problem. The risk is higher for those with pre-existing heart rhythm issues or those taking certain other medications. Inform your healthcare provider about all medications and supplements you are using.

• Electrolyte Changes: Posaconazole may alter levels of electrolytes like potassium, magnesium, and calcium. While generally minor, significant imbalances can affect heart function. It is important to adhere to scheduled blood tests.

• Drug Interactions: Posaconazole interacts with a wide range of medications, including over-the-counter products, which can lead to serious or potentially life-threatening effects. Ensure your healthcare provider is aware of all substances you are taking.

• Transplant Medication Interactions: The drug interacts with calcineurin inhibitors used by transplant patients, such as cyclosporine and tacrolimus, potentially leading to severe complications like brain or kidney damage.

• Midazolam Interaction: Posaconazole can cause midazolam levels to rise, increasing the risk of side effects. Do not combine these medications and inform your healthcare provider if you are taking midazolam.

• Vincristine Interaction: Concurrent use with the cancer medication vincristine may result in severe side effects like seizures and nerve damage. Discuss with your healthcare team if no alternative treatments are available.

• Venetoclax Interaction: Combining with venetoclax can increase the risk of severe side effects, including tumor lysis syndrome and infections. Review your medication list with your provider.

• Hereditary Fructose Intolerance: The Noxafil PowderMix contains sorbitol, unsuitable for those with hereditary fructose intolerance (HFI), potentially causing life-threatening issues.

Contraindications: Avoid posaconazole if you:

• Are allergic to azole antifungals.
• Are taking sirolimus, certain medications that cause QT prolongation, specific statins, ergot alkaloids, or have hereditary fructose intolerance.
• Are using Venclexta (venetoclax).

Please consult your healthcare provider to ensure posaconazole is safe for you, especially if any of the above conditions or risks apply.

Common side effects:

• Nausea
• Vomiting
• Diarrhea
• Headache
• Dizziness
• Stomach upset
• Mild rash

Less common but important to monitor:

• Fever
• Low potassium levels
• Cough
• Swelling in the arms or legs
• Lower blood cell counts
• Constipation
• Stomach pain
• Weakness
• Chills
• High blood pressure

Serious side effects:

• Symptoms suggesting liver problems (persistent nausea, stomach pain, yellowing of the skin or eyes, flu-like symptoms)
• Abnormal heart rhythms (irregular heartbeat, chest pain, severe dizziness)
• Changes in electrolytes (muscle cramps, weakness, fatigue)
• Severe allergic reactions (rash, itching, swelling of the face, tongue, or throat, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Alfuzosin
• Alprazolam
• Amiodarone
• Atorvastatin
• Clarithromycin
• Lovastatin
• Simvastatin
• Sirolimus
• Pimozide
• Quinidine
• Ergotamine
• Dihydroergotamine
• Dronedarone
• Venetoclax

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Acalabrutinib
• Cimetidine
• Efavirenz
• Esomeprazole
• Phenytoin
• Rifabutin
• Midazolam
• Rivaroxaban
• Pacritinib

Interactions with low risk that usually do not require a change in therapy:

• Aripiprazole Lauroxil
• Lorazepam
• Topiramate