Patient leaflet - Posaconazole Milpharm 40 mg/ml oral suspension
1. What Posaconazole Milpharm is and what it is used for
Posaconazole Milpharm contains a medicine called posaconazole. This belongs to a group of medicines called “antifungals”. It is used to prevent and treat many different fungal infections.
This medicine works by killing or stopping the growth of some types of fungi that can cause infections.
Posaconazole Milpharm can be used in adults to treat the following types of fungal infections when other antifungal medicines have not worked or you have had to stop taking them:
infections caused by fungi of the Aspergillus family that have not improved during
treatment with the anti-fungal medicines amphotericin B or itraconazole or when these medicines have had to be stopped;
infections caused by fungi of the Fusarium family that have not improved during
treatment with amphotericin B or when amphotericin B has had to be stopped;
infections caused by fungi that cause the conditions known as “chromoblastomycosis”
and “mycetoma” that have not improved during treatment with itraconazole or when itraconazole has had to be stopped;
infections caused by a fungus called Coccidioides that have not improved during
treatment with one or more of amphotericin B, itraconazole or fluconazole or when these medicines have had to be stopped.
Infections in the mouth or throat area (known as “thrush”) caused by fungi called
Candida, which were not previously treated.
This medicine can also be used to prevent fungal infections in adults who are at high risk of getting a fungal infection, such as:
patients who have a weak immune system due to having chemotherapy for “acute
myelogenous leukaemia” (AML) or “myelodysplastic syndromes” (MDS)
patients having “high-dose immunosuppressive therapy” after “hematopoietic stem cell
transplant” (HSCT).
2. What you need to know before you take Posaconazole Milpharm
Do not take Posaconazole Milpharm if:
you are allergic to posaconazole or any of the other ingredients of this medicine (listed in
you are taking: terfenadine, astemizole, cisapride, pimozide, halofantrine, quinidine, any
medicines that contain “ergot alkaloids” such as ergotamine or dihydroergotamine, or a “statin” such as simvastatin, atorvastatin or lovastatin.
you have just started taking venetoclax or your venetoclax dose is being slowly
increased for treatment of chronic lymphocytic leukaemia (CLL).
Do not take Posaconazole Milpharm if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Posaconazole Milpharm.
See “Other medicines and Posaconazole Milpharm” below for more information including information on other medicines which may interact with Posaconazole Milpharm.
Warnings and precautions
Talk to your doctor, pharmacist or nurse before taking Posaconazole Milpharm if you:
have had an allergic reaction to another antifungal medicine such as ketoconazole,
fluconazole, itraconazole or voriconazole.
have or have ever had liver problems. You may need to have blood tests while you are
taking this medicine.
develop severe diarrhoea or vomiting, as these conditions may limit the effectiveness of
this medicine.
have an abnormal heart rhythm tracing (ECG) that shows a problem called long QTc
interval
- have a weakness of the heart muscle or heart failure
- have a very slow heartbeat
- have heart rhythm disturbance
- have any problem with potassium, magnesium or calcium levels in your blood
are taking vincristine, vinblastine and other “vinca alkaloids” (medicines used to treat
cancer).
- are taking venetoclax (a medicine used to treat cancer).
If any of the above apply to you (or you are not sure), talk to your doctor, pharmacist or nurse before taking Posaconazole Milpharm.
If you develop severe diarrhoea or vomiting (being sick) while taking Posaconazole Milpharm, talk to your doctor, pharmacist or nurse straight away, as this may stop it from working properly. See section 4 for more information.
Children
Posaconazole Milpharm should not be used in children and adolescents (17 years of age and younger).
You should avoid sun exposure while being treated. It is important to cover sun exposed areas of skin with protective clothing and use sunscreen with a high sun protection factor (SPF), as an increased sensitivity of skin to the sun’s UV rays can occur.
Other medicines and Posaconazole Milpharm
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
Do not take Posaconazole Milpharm if you are taking any of the following:
- terfenadine (used to treat allergies)
- astemizole (used to treat allergies)
- cisapride (used to treat stomach problems)
- pimozide (used to treat symptoms of Tourette's and mental illness)
- halofantrine (used to treat malaria)
- quinidine (used to treat abnormal heart rhythms).
Posaconazole Milpharm can increase the amount of these medicines in the blood which may lead to very serious changes to your heart rhythm:
any medicines that contain “ergot alkaloids” such as ergotamine or dihydroergotamine
used to treat migraines. Posaconazole can increase the amount of these medicines in the blood which may lead to a severe decrease in blood flow to your fingers or toes and could cause damage to them.
- a “statin” such as simvastatin, atorvastatin or lovastatin used to treat high cholesterol.
- venetoclax when used at the start of the treatment of a type of cancer, chronic lymphocytic leukaemia (CLL)
Do not take Posaconazole Milpharm if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking this medicine.
Other medicines
Look at the list of medicines given above that must not be taken while you are taking Posaconazole Milpharm. In addition to the medicines named above there are other medicines that carry a risk of rhythm problems that may be greater when they are taken with Posaconazole Milpharm. Please make sure you tell your doctor about all the medicines you are taking (prescribed or non-prescribed).
Certain medicines may increase the risk of side effects of Posaconazole Milpharm by increasing the amount of Posaconazole in the blood.
The following medicines may decrease the effectiveness of Posaconazole Milpharm by decreasing the amount of Posaconazole in the blood:
- rifabutin and rifampicin (used to treat certain infections). If you are already taking rifabutin, you will need a blood test and you will need to look out for some possible side effects of rifabutin.
- some medicines used to treat or prevent fits including; phenytoin, carbamazepine, phenobarbital or primidone.
- efavirenz and fosamprenavir used to treat HIV infection.
- medicines used to decrease stomach acid such as cimetidine and ranitidine or omeprazole and similar medicines that are called proton pump inhibitors.
- Flucloxacillin (antibiotic used against bacterial infections)
Posaconazole Milpharm may possibly increase the risk of side effects of some other medicines by increasing the amount of these medicines in the blood. These medicines include:
- vincristine, vinblastine and other “vinca alkaloids” (used to treat cancer)
- venetoclax (used to treat cancer)
- ciclosporin (used during or after transplant surgery)
- tacrolimus and sirolimus (used during or after transplant surgery)
- rifabutin (used to treat certain infections)
- medicines used to treat HIV called protease inhibitors (including lopinavir and atazanavir, which are given with ritonavir)
- midazolam, triazolam, alprazolam or other “benzodiazepines” (used as sedatives or muscle relaxants)
- diltiazem, verapamil, nifedipine, nisoldipine or other “calcium channel blockers” (used to treat high blood pressure)
- digoxin (used to treat heart failure)
- glipizide or other “sulfonylureas” (used to treat high blood sugar).
- all-trans retinoic acid (ATRA), also called tretinoin (used to treat certain blood cancers).
If any of the above apply to you (or you are not sure), talk to your doctor or pharmacist before taking Posaconazole Milpharm.
Posaconazole Milpharm with food and drink
To improve absorption of posaconazole, whenever possible it should be taken during or immediately after food or a nutritional drink (see section 3 “How to take Posaconazole Milpharm”). There is no information on the effect of alcohol on posaconazole.
Pregnancy and breast-feeding
Tell your doctor if you are or think you are pregnant before you start to take Posaconazole Milpharm.
Do not take Posaconazole Milpharm if you are pregnant unless you are told to by your doctor.
If you are a woman who could become pregnant you should use effective contraception while you are taking this medicine. If you become pregnant while you are taking Posaconazole Milpharm, contact your doctor straight away.
Do not breast-feed while taking Posaconazole Milpharm. This is because small amounts may pass into breast milk.
Driving and using machines
You may feel dizzy, sleepy, or have blurred vision while taking Posaconazole Milpharm, which may affect your ability to drive or use tools or machines. If this happens, do not drive or use any tools or machines and contact your doctor.
Posaconazole Milpharm contains Benzyl alcohol
This medicine contains less than 0.3 mg benzyl alcohol in each ml oral suspension dosage. Benzyl alcohol may cause allergic reactions.
Ask your doctor or pharmacist for advice if you are pregnant or breast-feeding or if you have a liver or kidney disease. This is because large amounts of benzyl alcohol can build-up in your body and may cause side effects (called “metabolic acidosis”).
Posaconazole Milpharm contains Propylene glycol
This medicine contains 9.4 mg propylene glycol in each ml.
Posaconazole Milpharm contains benzoic acid
This medicine contains less than 0.03 mg benzoic Acid in each ml oral suspension dosage.
Posaconazole Milpharm contains sodium benzoate
This medicine contains 10 mg of sodium benzoate (E211) per 5 mL of suspension.
Posaconazole Milpharm contains glucose
Posaconazole Milpharm contains approximately 1.75 g of glucose per 5 mL of suspension. You should not take this medicine if you have a condition called glucose-galactose malabsorption and should take note of this amount of glucose if you need to watch your sugar intake for any reason.
Posaconazole Milpharm contains Sodium
This medicine contains less than 1 mmol sodium (23 mg) per ml, that is to say essentially ‘sodium-free’.
3. How to use Posaconazole Milpharm
Do not switch between taking Posaconazole tablets and Posaconazole Milpharm oral suspension without talking to your doctor or pharmacist because it may result in a lack of efficacy or an increased risk of adverse reactions.
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Your doctor will monitor your response and condition to determine how long Posaconazole Milpharm needs to be given and whether any change is needed to your daily dose.
The table below shows the recommended dose and length of treatment which depend on the type of infection that you have and may be individually adapted for you by your doctor. Do not adapt your dose yourself before consulting your doctor or change your treatment regime.
Whenever possible you should take Posaconazole Milpharm during or immediately after food or a nutritional drink.
Package leaflet: Information for the user
Posaconazole Milpharm 40 mg/mL oral suspension
posaconazole
Version: 09
Date & Time: 07.10.2024 & 4.10 pm
Submission Code: N11870_u3
Indication Recommended dose and length of treatment
Treatment of refractory Fungal
Infections (Invasive aspergillosis,
Fusariosis,
Chromoblastomycosis/
Mycetoma,
Coccidioidomycosis)
The recommended dose is 200 mg (one 5 mL spoonful) taken four times daily.
Alternatively, if recommended by your doctor, you may take 400 mg (two 5 mL spoonfuls) twice a day provided that you are able to take both doses during or after food or a nutritional drink.
First time treatment of Thrush On the first day of treatment take 200 mg (one 5 mL
spoonful) once. After the first day, take 100 mg (2.5 mL) once a day.
Prevention of serious Fungal
Infections
Take 200 mg (one 5 mL spoonful) three times a day.
If you take more Posaconazole Milpharm than you should
If you are concerned that you may have taken too much, contact your doctor or healthcare professional immediately.
If you forget to take Posaconazole Milpharm
If you have missed a dose, take it as soon as you remember and then carry on as before. However, if it is almost time for your next dose, take your dose when it is due. Do not take a double dose to make up for a forgotten dose.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Serious side effects
Tell your doctor, pharmacist or nurse straight away if you notice any of the following serious side effects – you may need urgent medical treatment:
- nausea or vomit (feeling or being sick), diarrhoea
signs of liver problems - these include yellowing of your skin or whites of the eyes,
unusually dark urine or pale faeces, feeling sick for no reason, stomach problems, loss of appetite or unusual tiredness or weakness, an increase in liver enzymes shown up in blood tests
- allergic reaction
Other side effects
Tell your doctor, pharmacist or nurse if you notice any of the following side effects:
Common: the following may affect up to 1 in 10 people
a change in the salt level in your blood shown in blood tests - signs include feeling
confused or weak
abnormal skin sensations, such as numbness, tingling, itching, creeping, pricking or
burning
- headache
- low potassium levels – shown up in blood tests
- low magnesium levels – shown up in blood tests
- high blood pressure
loss of appetite, stomach pain or upset stomach, passing wind, dry mouth, changes in
your taste
- heartburn (a burning sensation in the chest rising up to the throat)
low levels of “neutrophils” a type of white blood cell (neutropenia) –this can make you
more likely to get infections and be shown up in blood tests
- fever
- feeling weak, dizzy, tired or sleepy
- rash
- itching
- constipation
- rectal discomfort
Uncommon: the following may affect up to 1 in 100 people
anaemia - signs include headaches, feeling tired or dizzy, being short of breath or looking
pale and a low level of haemoglobin shown up in blood tests
- low level of platelets (thrombocytopenia) shown in blood tests – this may lead to bleeding
low level of “leukocytes” a type of white blood cell (leukopenia) shown in blood tests –
this can make you more likely to get infections
high level of “eosinophils” a type of white blood cell (eosinophilia) – this can happen if
you have inflammation
- inflammation of the blood vessels
- heart rhythm problems
- fits (convulsions)
- nerve damage (neuropathy)
abnormal heart rhythm – shown up on a heart trace (ECG), palpitations, slow or fast
heartbeat,high or low blood pressure
- low blood pressure
- inflammation of the pancreas (pancreatitis) – this may cause severe stomach pain
oxygen supply to the spleen is interrupted (splenic infarction) - this may cause severe
stomach pain
severe kidney problems – signs include passing more or less urine, that is a different
colour than usual
- high blood levels of creatinine – shown in blood tests
- cough, hiccups
- nose bleeds
- severe sharp chest pain when breathing in (pleuritic pain)
- swelling of lymph glands (lymphadenopathy)
- reduced feeling of sensitivity especially on the skin
- tremor
- high or low blood sugar levels
- blurred vision, sensitivity to light
- hair loss (alopecia)
- mouth ulcers
- shivering, feeling generally unwell
- pain, back or neck pain, pain in arms or legs
- water retention (oedema)
- menstrual problems (abnormal vaginal bleeding)
- inability to sleep (insomnia)
- being completely or partially unable to talk
- swelling of the mouth
- abnormal dreams, or difficulty sleeping
- problems with co-ordination or balance
- mucosal inflammation
- stuffy nose
- difficulty breathing
- chest discomfort
- feeling bloated
mild to severe nausea, vomiting, cramps and diarrhoea, usually caused by a virus,
stomach pain
- belching
- feeling jittery
Rare: the following may affect up to 1 in 1,000 people
- pneumonia – signs include feeling short of breath and producing discoloured phlegm
high blood pressure in the blood vessels in the lungs (pulmonary hypertension) this can
cause serious damage to your lungs and heart
- blood problems such as unusual blood clotting or prolonged bleeding
- severe allergic reactions, including widespread blistering rash and skin peeling
- mental problems such as hearing voices or seeing things that are not there
- fainting
- having problems thinking or talking, having jerking movements, especially in your hands that you cannot control
- stroke – signs include pain, weakness, numbness, or tingling in the limbs
- having a blind or dark spot in your field of vision
- heart failure or heart attack which could lead to the heart stopping beating and death, heart rhythm problems, with sudden death
- blood clots in your legs (deep vein thrombosis) – signs include intense pain or swelling of the legs
- blood clots in your lungs (pulmonary embolism) – signs include feeling short of breath or pain while breathing
- bleeding into your stomach or gut – signs include vomiting blood or passing blood in your stool
- a blockage in your gut (intestinal obstruction) especially in the “ileum”. The blockage will prevent the contents of your intestine from passing through to the lower bowel - signs include feeling bloated, vomiting, severe constipation, loss of appetite, and cramps
- “haemolytic uraemic syndrome” when red blood cells breakup (haemolysis) which may happen with or without kidney failure
- “pancytopenia” low level of all blood cells (red and white blood cells and platelets) shown in blood tests
- large purple discolourations on the skin (thrombotic thrombocytopenic purpura)
- swelling of the face or tongue
- depression
- double vision
- breast pain
- adrenal glands not working properly – this may cause weakness, tiredness, loss of appetite, skin discolouration
- pituitary gland not working properly – this may cause low blood levels of some hormones that affect the function of the male or female sex organs
- hearing problems
pseudoaldosteronism, which results in high blood pressure with a low potassium level
(shown in blood test)
Not known: frequency cannot be estimated from the available data
- some patients have also reported feeling confused after taking Posaconazole Milpharm.
- Redness of the skin
Tell your doctor, pharmacist or nurse if you notice any of the side effects listed above.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yelow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Posaconazole Milpharm
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the label and carton after EXP. The expiry date refers to the last day of that month.
This medicine does not require any special storage conditions.
Do not freeze.
If you have any suspension left in a bottle more than 45 days after it was first opened, you should not use this medicine. Please return the bottle containing any leftover suspension to your pharmacist.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information
What Posaconazole Milpharm contains
- Each millilitre of oral suspension contains 40 milligrams of posaconazole.
- The other ingredients are polysorbate 80, simethicone emulsion (30%) (contains water, polydimethylsiloxane, polyethylene glycol sorbitan tristearate, methylcellulose, silica gel, polyethylene glycol stearate, sorbic acid, benzoic acid, sulfuric acid), sodium citrate (E331), citric acid monohydrate (E330), xanthan gum, sodium benzoate (E211), liquid glucose, glycerol (85%), titanium dioxide (E171), cherry flavour (contains propylene glycol (E1520), benzaldehyde, benzyl alcohol, aldehyde C20, vanillin, allyl caproate, amyl acetate, citrus oil, alpha ionone, benzyl acetate and phenyl ethyl acetate).
What Posaconazole Milpharm looks like and contents of the pack
Posaconazole is a white to off-white cherry flavoured, 105 mL oral suspension packaged in 125 mL amber coloured glass bottles (Type-III) closed with a child-resistant cap (polypropylene). A measuring spoon is provided with each bottle for measuring 2.5 and 5 mL doses of the oral suspension.
Marketing Authorisation Holder
Milpharm Limited
Ares Block, Odyssey Business Park
West End Road
South Ruislip HA4 6QD
United Kingdom
Manufacturer
APL Swift Services (Malta) Limited
HF26, Hal Far Industrial Estate, Hal Far
Birzebbugia, BBG 3000
Malta
or
Generis Farmaceutica, S.A.,
Rua Joao de Deus, n o 19,
Venda Nova, 2700-487 Amadora, Portugal
or
Arrow Generiques – Lyon
26 avenue Tony Garnier
Lyon, 69007, France