OBJECT DRUGS

Azole Antifungals:

• Itraconazole (Sporanox, etc.)
• Ketoconazole (Nizoral, etc.)
• Posaconazole (Noxafil)

PRECIPITANT DRUGS

Gastric Alkalinizers:

• Antacids
• Didanosine (Videx, etc.)
• Sucralfate (Carafate)

Comment:

Itraconazole, ketoconazole, and posaconazole suspension require gastric acidity to be absorbed. Any agent that increases gastric pH can impair their bioavailability. Sucralfate, although not strictly a gastric alkalinizer, has also been noted to reduce the absorption of itraconazole and ketoconazole.

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. The interaction does not occur with enteric coated bead formulation of didanosine (Videx EC). Administer itraconazole or ketoconazole 2 or more hours prior to antacid, sucralfate, or didanosine. Wait six hours after gastric alkalinizer administration to give itraconazole or ketoconazole.
• Monitor:Monitor for reduced antifungal effect if itraconazole, ketoconazole, or posaconazole is used with a gastric alkalinizer or sucralfate.