OBJECT DRUGS
Azole Antifungals:
- Itraconazole (Sporanox, etc.)
- Ketoconazole (Nizoral, etc.)
- Posaconazole (Noxafil)
PRECIPITANT DRUGS
Gastric Antisecretory Agents:
- Cimetidine (Tagamet, etc.)
- Dexlansoprazole (Kapidex)
- Esomeprazole (Nexium, etc.)
- Famotidine (Pepcid, etc.)
- Lansoprazole (Prevacid, etc.)
- Nizatidine (Axid, etc.)
- Omeprazole (Prilosec, etc.)
- Pantoprazole (Protonix, etc.)
- Rabeprazole (Aciphex)
- Ranitidine (Zantac, etc.)
Comment:
Itraconazole, ketoconazole, and posaconazole suspension require gastric acidity to be absorbed. Any agent that increases gastric pH can impair their bioavailability.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative: Consider fluconazole (Diflucan), voriconazole (Vfend), or terbinafine (Lamisil) if suitable for the infection.
- Circumvent/Minimize: The bioavailability of itraconazole solution and posaconazole delayed release tablets are not affected by changes in gastric pH. If an antisecretory agent is necessary, consider using a larger dose of itraconazole or ketoconazole, with monitoring of antifungal serum concentrations if possible. The administration of the antifungal with Coca-Cola or Pepsi will acidify the stomach and improve the absorption of the antifungal; however a reduction in bioavailability will still occur.
- Monitor:Monitor for reduced antifungal effect if itraconazole, ketoconazole, or posaconazole is used with a gastric antisecretory agents.