Skip to main content

Drug Interactions between coccidioidin skin test and Noxafil

This report displays the potential drug interactions for the following 2 drugs:

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

coccidioidin skin test posaconazole

Applies to: coccidioidin skin test and Noxafil (posaconazole)

MONITOR: Antifungal medications may interfere with delayed-type hypersensitivity responses to the coccidioidin skin test in patients with a history of pulmonary coccidioidomycosis, potentially resulting in incorrect results. The mechanism of this theoretical interaction is not described in the package labeling, but may involve the ability of antifungal agents to modify cellular functions of the immune system, potentially affecting the patient's delayed-type hypersensitivity reaction to the coccidioidin skin test. Clinical data are limited and conflicting. Receipt of concurrent or previous systemic antifungal therapy did not appear to interfere with or accentuate the induration response to the coccidioidin skin test, according to data obtained from a study in healthy adult subjects who had recently recovered from acute primary pulmonary coccidioidomycosis in Bakersfield, CA and Tucson, AZ. In contrast, a different small study at the Southern Arizona Veterans Affairs Health Care System of subjects with non-meningeal coccidioidomycosis identified receipt of antifungal medication as a factor related to a failure to express delayed-type hypersensitivity to the coccidioidin skin test. However, the authors of this study suggest that factors such as receipt of antifungal medication may be indicators of patients with less intact immunity or more severe coccidioidomycosis and perhaps that is the reason that these patients did not express delayed-type hypersensitivity to the skin test.

MANAGEMENT: Until more data are available, caution may be advisable if use of the coccidioidin skin test is being considered in a patient with a history of pulmonary coccidioidomycosis who is also on systemic antifungal medication(s). Clinicians should be aware of the potential for interference with delayed-type hypersensitivity responses in patients on concomitant antifungal agents.

References (8)
  1. (2023) "Product Information. Spherusol (coccidioidin skin test)." Nielsen Biosciences Inc
  2. Pawelec G, Ehninger G, Rehbein A, Schaudt K, Jaschonek K (1991) "Comparison of the immunosuppressive activities of the antimycotic agents itraconazole, fluconazole, ketoconazole and miconazole on human T-cells." Int J Immunopharmacol, 13, p. 299-304
  3. Johnson R, Kernerman SM, Rastogi SC, Nielsen HS, Ampel NM, Sawtelle BG (2012) "A reformulated spherule-derived coccidioidin (Spherusol) to detect delayed-type hypersensitivity in coccidioidomycosis." Mycopathologia, 174, p. 353-8
  4. Ampel NM, Robey I, Nguyen CT (2019) "An analysis of skin test responses to spherulin-based coccidioidin (Spherusol) among a group of subjects with various forms of active coccidioidomycosis." Mycopathologia, 184, p. 533-8
  5. Kirkland TN, Hung CY, Shubitz LF, Beyhan S, Fierer J (2024) The host response to coccidioidomycosis. https://www.mdpi.com/2309-608X/10/3/173
  6. Kupers TA, Petrich JM, Holloway AW, St. Geme JW (1970) "Depression of tuberculin delayed hypersensitivity by live attenuated mumps virus." J Pediatr, 76, p. 716-21
  7. Ries F, Alflen A, Aranda Lopez P, et al. (2019) "Antifungal drugs influence neutrophil effector functions." Antimicrob Agents Chemother, 63, e02409-18
  8. Kretschmar M, Geginat G, Bertsch T, Walter S, Hof H, Nichterlein T (2001) "Influence of liposomal amphotericin B on CD8 T-cell function." Antimicrob Agents Chemother, 45, p. 2383-5

Drug and food interactions

Moderate

posaconazole food

Applies to: Noxafil (posaconazole)

ADJUST DOSING INTERVAL: Food significantly increases the absorption of posaconazole from the oral suspension but only modestly from the delayed-release tablet. Following single-dose administration, posaconazole mean peak plasma concentration (Cmax) and systemic exposure (AUC) are approximately 2.5 to 3 times higher when the oral suspension is given with a nonfat meal or a nutritional supplement (14 grams of fat) than when given under fasting conditions, and approximately 3.5 to 4 times higher when given during or 20 minutes after a high-fat meal (50 grams of fat) than under fasting conditions. Acidic beverages may also increase posaconazole absorption. In 12 healthy volunteers, administration of a single 400 mg dose of posaconazole suspension with 12 ounces of ginger ale increased posaconazole Cmax by 92% and AUC by 70% compared to administration after fasting. In contrast, the Cmax and AUC of posaconazole increased by just 16% and 51%, respectively, when posaconazole tablets were given as a single 300 mg dose to healthy volunteers after a high-fat meal relative to a fasted state.

GENERALLY AVOID Concomitant use of alcohol and posaconazole administered in the form of delayed-release oral suspension may lead to a faster release of posaconazole. An in vitro dissolution study determined a potential for alcohol-induced dose-dumping with the delayed-release oral suspension of posaconazole.

MONITOR: In 5 study subjects, posaconazole Cmax decreased by 27% to 53% and AUC decreased by 33% to 51% when the oral suspension was administered via a nasogastric tube as opposed to orally.

MANAGEMENT: Posaconazole tablets should be taken with food, whereas posaconazole oral suspension should be administered during or immediately (i.e., within 20 minutes) following a full meal to enhance bioavailability. Patients who cannot eat a full meal should take the suspension with a liquid nutritional supplement or an acidic carbonated beverage such as ginger ale. In patients who cannot eat a full meal or tolerate an oral nutritional supplement or an acidic carbonated beverage and who do not have the option of taking another formulation of posaconazole, alternative antifungal therapy should be considered; otherwise, monitor patients closely for breakthrough fungal infections. Patients receiving posaconazole via a nasogastric tube should also be closely monitored due to increased risk of treatment failure associated with lower plasma exposure. Administration of alcohol with posaconazole from the delayed-release oral suspension formulation is not recommended.

References (4)
  1. (2006) "Product Information. Noxafil (posaconazole)." Schering-Plough Corporation
  2. Sansone-Parsons A, Krishna G, Calzetta A, et al. (2006) "Effect of a nutritional supplement on posaconazole pharmacokinetics following oral administration to healthy volunteers." Antimicrob Agents Chemother, 50, p. 1881-3
  3. Krishna G, Moton A, Ma L, Malavade D, Medlock M, McLeod J (2008) "Effect of gastric pH, dosing regimen and prandial state, food and meal timing relative to dose, and gastro-intestinal motility on absorption and pharmacokinetics of the antifungal posaconazole." 18th European Congress of Clinical Microbiology and Infectious Diseases, April, p. 20
  4. Walravens J, Brouwers J, Spriet I, Tack J, Annaert P, Augustijns P (2011) "Effect of pH and Comedication on Gastrointestinal Absorption of Posaconazole: Monitoring of Intraluminal and Plasma Drug Concentrations." Clin Pharmacokinet, 50, p. 725-34

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

Report options

Loading...
QR code containing a link to this page

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer