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.