Merck to Revise Noxafil Labeling

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FDA has required Merck to revise the labeling on two oral formulations of its antifungal Noxafil (posaconazole) due to dosing errors. The labels will now indicate that the two oral formulations cannot be directly substituted for each other but require a change in dose, an agency notice says.“Direct mg for mg substitution of the two formulations can result in drug levels that are lower or higher than needed to effectively treat certain fungal infections,” it says. Noxafil is approved in two oral formulations — an oral suspension and a delayed-release tablet.

Noxafil delayed-release tablets were approved 11/2013, and since then the agency says it has received 11 reports involving the wrong oral formulations being prescribed or dispensed to patients. “One case resulted in death, and an additional case resulted in hospitalization,” the notice says. “According to the reports, these outcomes were a result of health care professionals not knowing that the two oral formulations cannot be substituted for each other without adjusting the dose due to differences in how the medicine is absorbed and handled by the body.”

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