The Food and Drug Administration (FDA) has approved an update to the labeling for Noxafil (posaconazole Merck) regarding an interaction with vincristine. 

Noxafil, an azole antifungal, is indicated for the prophylaxis of invasive Aspergillus and Candida infections in patients who are at high risk of developing these infections due to being severely immunocompromised, such as HSCT recipients with GVHD or those with hematologic malignancies with prolonged neutropenia from chemotherapy; and for the treatment of oropharyngeal candidiasis (OPC), including OPC refractory (rOPC) to itraconazole and/or fluconazole. 

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The labeling update under Warnings and Precautions states that concomitant administration of azole antifungals, including posaconazole, with vincristine has been associated with neurotoxicity and other serious adverse reactions, including seizures, peripheral neuropathy, syndrome of inappropriate antidiuretic hormone secretion, and paralytic ileus. For patients receiving vinca alkaloids, including vincristine, azole antifungals should be reserved for those who have no alternative antifungal treatment options. Posaconazole may increase the plasma levels of vinca alkaloids, which may lead to neurotoxicity and other serious reactions. 

Noxafil is available as an 18mg/mL strength injection, 100mg delayed-release tablets, and as a 40mg/mL strength cherry-flavored oral suspension.

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