Posaconazole AHCL

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ANNEX I 

 
SUMMARY OF PRODUCT CHARACTERISTICS 



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1. NAME OF THE MEDICINAL PRODUCT 
 
Posaconazole AHCL 40 mg/mL oral suspension 
 
 
2. QUALITATIVE AND QUANTITATIVE COMPOSITION 
 
Each mL of oral suspension contains 40 mg of posaconazole. 
 
Excipient(s) with known effect  
 
This medicinal product contains approximately 1.75 g of glucose per 5 mL of suspension. 
 
For the full list of excipients, see section 6.1. 
 
 
3. PHARMACEUTICAL FORM 
 
Oral suspension 
 
White to off-white free flowing suspension. 
 
 
4. CLINICAL PARTICULARS 
 
4.1 Therapeutic indications 
 
Posaconazole AHCL oral suspension is indicated for use in the treatment of the following fungal 
infections in adults (see section 5.1): 
- Invasive aspergillosis in patients with disease that is refractory to amphotericin B or 

itraconazole or in patients who are intolerant of these medicinal products; 
- Fusariosis in patients with disease that is refractory to amphotericin B or in patients who are 

intolerant of amphotericin B; 
- Chromoblastomycosis and mycetoma in patients with disease that is refractory to itraconazole 

or in patients who are intolerant of itraconazole; 
- Coccidioidomycosis in patients with disease that is refractory to amphotericin B, itraconazole or 

fluconazole or in patients who are intolerant of these medicinal products. 
- Oropharyngeal candidiasis: as first-line therapy in patients who have severe disease or are 

immunocompromised, in whom response to topical therapy is expected to be poor. 
 
Refractoriness is defined as progression of infection or failure to improve after a minimum of 7 days 
of prior therapeutic doses of effective antifungal therapy. 
 
Posaconazole AHCL oral suspension is also indicated for prophylaxis of invasive fungal infections in 
the following patients: 
- Patients receiving remission-induction chemotherapy for acute myelogenous leukemia (AML) 

or myelodysplastic syndromes (MDS) expected to result in prolonged neutropenia and who are 
at high risk of developing invasive fungal infections; 

- Hematopoietic stem cell transplant (HSCT) recipients who are undergoing high-dose 
immunosuppressive therapy for graft versus host disease and who are at high risk of developing 
invasive fungal infections. 

 



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4.2 Posology and method of administration 
 
Non-Interchangeability between posaconazole tablets and Posaconazole AHCL Oral Suspension 
 
The tablet and oral suspension are not to be used interchangeably due to the differences between these 
two formulations in frequency of dosing, administration with food and plasma drug concentration 
achieved. Therefore, follow the specific dosage recommendations for each formulation.  
 
Treatment should be initiated by a physician experienced in the management of fungal infections or in 
the supportive care in the high risk patients for which posaconazole is indicated as prophylaxis. 
 
Posology 
 
Posaconazole is also available as 100 mg gastro-resistant tablet and 300 mg concentrate for solution 
for infusion. Posaconazole tablets are the preferred formulation to optimize plasma concentrations and 
generally provide higher plasma drug exposures than posaconazole oral suspension. 
 
Recommended dose is shown in Table 1. 
 
Table 1. Recommended dose according to indication.  
Indication Dose and duration of therapy 

(See section 5.2) 
Refractory invasive fungal infections 
(IFI)/patients with IFI intolerant to 1st 
line therapy 

200 mg (5 mL) four times a day. Alternatively, patients who 
can tolerate food or a nutritional supplement may take 400 
mg (10 mL) twice a day during or immediately following a 
meal or nutritional supplement. 
Duration of therapy should be based on the severity of the 
underlying disease, recovery from immunosuppression, and 
clinical response. 

Oropharyngeal candidiasis Loading dose of 200 mg (5 mL) once a day on the first day, 
then 100 mg (2.5 mL) once a day for 13 days. 
Each dose of Posaconazole AHCL should be administered 
during or immediately after a meal, or a nutritional 
supplement in patients who cannot tolerate food to enhance 
the oral absorption and to ensure adequate exposure 

Prophylaxis of invasive fungal 
infections 

200 mg (5 mL) three times a day. Each dose of Posaconazole 
AHCL should be administered during or immediately after a 
meal, or a nutritional supplement in patients who cannot 
tolerate food to enhance the oral absorption and to ensure 
adequate exposure. The duration of therapy is based on 
recovery from neutropenia or immunosuppression. For 
patients with acute myelogenous leukemia or 
myelodysplastic syndromes, prophylaxis with Posaconazole 
AHCL should start several days before the anticipated onset 
of neutropenia and continue for 7 days after the neutrophil 
count rises above 500 cells per mm3. 

 
Special populations 
 
Renal impairment 
An effect of renal impairment on the pharmacokinetics of posaconazole is not expected and no dose 
adjustment is recommended (see section 5.2). 
 
Hepatic impairment 
Limited data on the effect of hepatic impairment (including Child-Pugh C classification of chronic 
liver disease) on the pharmacokinetics of posaconazole demonstrate an increase in plasma exposure 
compared to subjects with normal hepatic function, but do not suggest that dose adjustment is 



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necessary (see sections 4.4 and 5.2). It is recommended to exercise caution due to the potential for 
higher plasma exposure. 
 
Paediatric population 
The safety and efficacy of posaconazole in children aged below 18 years have not been established. 
Currently available data are described in sections 5.1 and 5.2, but no recommendation on a posology 
can be made. 
 
Method of administration 
 
For oral use. 
The oral suspension must be shaken well before use. Bottles showing any visible settling should be 
vigorously shaken for a minimum of 10 seconds. 
 
4.3 Contraindications 
 
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.  
 
Co-administration with ergot alkaloids (see section 4.5). 
 
Co-administration with the CYP3A4 substrates terfenadine, astemizole, cisapride, pimozide, 
halofantrine or quinidine since this may result in increased plasma concentrations of these medicinal 
products, leading to QTc prolongation and rare occurrences of torsades de pointes (see sections 4.4 
and 4.5). 
 
Co-administration with the HMG-CoA reductase inhibitors simvastatin, lovastatin and atorvastatin 
(see section 4.5). 
 
4.4 Special warnings and precautions for use 
 
Hypersensitivity 
 
There is no information regarding cross-sensitivity between posaconazole and other azole antifungal 
agents. Caution should be used when prescribing Posaconazole AHCL to patients with 
hypersensitivity to other azoles. 
 
Hepatic toxicity 
 
Hepatic reactions (e.g. mild to moderate elevations in ALT, AST, alkaline phosphatase, total bilirubin 
and/or clinical hepatitis) have been reported during treatment with posaconazole. Elevated liver 
function tests were generally reversible on discontinuation of therapy and in some instances these tests 
normalised without interruption of therapy. Rarely, more severe hepatic reactions with fatal outcomes 
have been reported. 
Posaconazole should be used with caution in patients with hepatic impairment due to limited clinical 
experience and the possibility that posaconazole plasma levels may be higher in these patients (see 
sections 4.2 and 5.2). 
 
Monitoring of hepatic function 
 
Liver function tests should be evaluated at the start of and during the course of posaconazole therapy. 
Patients who develop abnormal liver function tests during Posaconazole AHCLtherapy must be 
routinely monitored for the development of more severe hepatic injury. Patient management should 
include laboratory evaluation of hepatic function (particularly liver function tests and bilirubin). 
Discontinuation of Posaconazole AHCL should be considered if clinical signs and symptoms are 
consistent with development of liver disease. 
 



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QTc prolongation 
Some azoles have been associated with prolongation of the QTc interval. Posaconazole AHCL must 
not be administered with medicinal products that are substrates for CYP3A4 and are known to prolong 
the QTc interval (see sections 4.3 and 4.5). Posaconazole AHCL should be administered with caution 
to patients with pro-arrhythmic conditions such as: 
- Congenital or acquired QTc prolongation 
- Cardiomyopathy, especially in the presence of cardiac failure 
- Sinus bradycardia 
- Existing symptomatic arrhythmias 
- Concomitant use with medicinal products known to prolong the QTc interval (other than those 

mentioned in section 4.3). 
Electrolyte disturbances, especially those involving potassium, magnesium or calcium levels, should 
be monitored and corrected as necessary before and during posaconazole therapy.  
 
Drug interactions 
 
Posaconazole is an inhibitor of CYP3A4 and should only be used under specific circumstances during 
treatment with other medicinal products that are metabolised by CYP3A4 (see section 4.5). 
 
Midazolam and other benzodiazepines 
 
Due to the risk of prolonged sedation and possible respiratory depression co-administration of 
posaconazole with any benzodiazepines metabolised by CYP3A4 (e.g. midazolam, triazolam, 
alprazolam) should only be considered if clearly necessary. Dose adjustment of benzodiazepines 
metabolised by CYP3A4 should be considered (see section 4.5). 
 
Vincristine toxicity 
 
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. Reserve 
azole antifungals, including posaconazole, for patients receiving a vinca alkaloid, including 
vincristine, who have no alternative antifungal treatment options (see section 4.5). 
 
Rifamycin antibacterials (rifampicin, rifabutin), certain anticonvulsants (phenytoin, carbamazepine, 
phenobarbital, primidone), efavirenz and cimetidine 
 
Posaconazole concentrations may be significantly lowered in combination; therefore, concomitant use 
with posaconazole should be avoided unless the benefit to the patient outweighs the risk (see section 
4.5). 
 
Gastrointestinal dysfunction 
 
There are limited pharmacokinetic data in patients with severe gastrointestinal dysfunction (such as 
severe diarrhoea). Patients who have severe diarrhoea or vomiting should be monitored closely for 
breakthrough fungal infections. 
 
Excipients 
 
This medicinal product contains approximately 1.75 g of glucose per 5 mL of suspension. Patients 
with glucose-galactose malabsorption should not take this medicine. 
 
This medicine contains less than 1 mmol sodium (23 mg) per 5 mL of suspension, that is to say 
essentially ‘sodium-free’. 
 



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4.5 Interaction with other medicinal products and other forms of interaction 
 
Effects of other medicinal products on posaconazole 
Posaconazole is metabolised via UDP glucuronidation (phase 2 enzymes) and is a substrate for 
p-glycoprotein (P-gp) efflux in vitro. Therefore, inhibitors (e.g. verapamil, ciclosporin, quinidine, 
clarithromycin, erythromycin, etc.) or inducers (e.g. rifampicin, rifabutin, certain anticonvulsants, etc.) 
of these clearance pathways may increase or decrease posaconazole plasma concentrations, 
respectively. 
 
Rifabutin 
Rifabutin (300 mg once a day) decreased the Cmax (maximum plasma concentration) and AUC (area 
under the plasma concentration time curve) of posaconazole to 57 % and 51 %, respectively. 
Concomitant use of posaconazole and rifabutin and similar inducers (e.g. rifampicin) should be 
avoided unless the benefit to the patient outweighs the risk. See also below regarding the effect of 
posaconazole on rifabutin plasma levels. 
 
Efavirenz 
Efavirenz (400 mg once a day) decreased the Cmax and AUC of posaconazole by 45 % and 50 %, 
respectively. Concomitant use of posaconazole and efavirenz should be avoided unless the benefit to 
the patient outweighs the risk.  
 
Fosamprenavir 
Combining fosamprenavir with posaconazole may lead to decreased posaconazole plasma 
concentrations. If concomitant administration is required, close monitoring for breakthrough fungal 
infections is recommended.  Repeat dose administration of fosamprenavir (700 mg twice daily x 
10 days) decreased the Cmax and AUC of posaconazole oral suspension (200 mg once daily on the 
1st day, 200 mg twice daily on the 2nd day, then 400 mg twice daily x 8 Days) by 21 % and 23 %, 
respectively. The effect of posaconazole on fosamprenavir levels when fosamprenavir is given with 
ritonavir is unknown. 
 
Phenytoin 
Phenytoin (200 mg once a day) decreased the Cmax and AUC of posaconazole by 41 % and 50 %, 
respectively. Concomitant use of posaconazole and phenytoin and similar inducers (e.g. 
carbamazepine, phenobarbital, primidone) should be avoided unless the benefit to the patient 
outweighs the risk. 
 
H2 receptor antagonists and proton pump inhibitors 
Posaconazole plasma concentrations (Cmax and AUC) were reduced by 39 % when posaconazole was 
administered with cimetidine (400 mg twice a day) due to reduced absorption possibly secondary to a 
decrease in gastric acid production. Co-administration of posaconazole with H2 receptor antagonists 
should be avoided if possible. Similarly, administration of 400 mg posaconazole with esomeprazole 
(40 mg daily) decreased mean Cmax and AUC by 46 % and 32 %, respectively, compared to dosing 
with 400 mg posaconazole alone. Co-administration of posaconazole with proton pump inhibitors 
should be avoided if possible. 
 
Food 
The absorption of posaconazole is significantly increased by food (see sections 4.2 and 5.2). 
 
Effects of posaconazole on other medicinal products 
 
Posaconazole is a potent inhibitor of CYP3A4. Co-administration of posaconazole with CYP3A4 
substrates may result in large increases in exposure to CYP3A4 substrates as exemplified by the 
effects on tacrolimus, sirolimus, atazanavir and midazolam below. Caution is advised during co- 
administration of posaconazole with CYP3A4 substrates administered intravenously and the dose of 
the CYP3A4 substrate may need to be reduced. If posaconazole is used concomitantly with CYP3A4 
substrates that are administered orally, and for which an increase in plasma concentrations may be 
associated with unacceptable adverse reactions, plasma concentrations of the CYP3A4 substrate 



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and/or adverse reactions should be closely monitored and the dose adjusted as needed. Several of the 
interaction studies were conducted in healthy volunteers in whom a higher exposure to posaconazole 
occurs compared to patients administered the same dose. The effect of posaconazole on CYP3A4 
substrates in patients might be somewhat lower than that observed in healthy volunteers, and is 
expected to be variable between patients due to the variable posaconazole exposure in patients. The 
effect of co-administration with posaconazole on plasma levels of CYP3A4 substrates may also be 
variable within a patient, unless posaconazole is administered in a strictly standardised way with food, 
given the large food effect on posaconazole exposure (see section 5.2). 
 
Terfenadine, astemizole, cisapride, pimozide, halofantrine and quinidine (CYP3A4 substrates) 
Co-administration of posaconazole and terfenadine, astemizole, cisapride, pimozide, halofantrine or 
quinidine is contraindicated. Co-administration may result in increased plasma concentrations of these 
medicinal products, leading to QTc prolongation and rare occurrences of torsades de pointes (see 
section 4.3). 
 
Ergot alkaloids 
Posaconazole may increase the plasma concentration of ergot alkaloids (ergotamine and 
dihydroergotamine), which may lead to ergotism. Co-administration of posaconazole and ergot 
alkaloids is contraindicated (see section 4.3). 
 
HMG-CoA reductase inhibitors metabolised through CYP3A4 (e.g. simvastatin, lovastatin, and 
atorvastatin) 
Posaconazole may substantially increase plasma levels of HMG-CoA reductase inhibitors that are 
metabolised by CYP3A4. Treatment with these HMG-CoA reductase inhibitors should be 
discontinued during treatment with posaconazole as increased levels have been associated with 
rhabdomyolysis (see section 4.3).  
 
Vinca alkaloids 
Most of the vinca alkaloids (e.g., vincristine and vinblastine) are substrates of CYP3A4. Concomitant 
administration of azole antifungals, including posaconazole, with vincristine has been associated with 
serious adverse reactions (see section 4.4). Posaconazole may increase the plasma concentrations of 
vinca alkaloids which may lead to neurotoxicity and other serious adverse reactions. Therefore, 
reserve azole antifungals, including posaconazole, for patients receiving a vinca alkaloid, including 
vincristine, who have no alternative antifungal treatment options. 
 
Rifabutin 
Posaconazole increased the Cmax and AUC of rifabutin by 31 % and 72 %, respectively. Concomitant 
use of posaconazole and rifabutin should be avoided unless the benefit to the patient outweighs the 
risk (see also above regarding the effect of rifabutin on plasma levels of posaconazole). If these 
medicinal products are co-administered, careful monitoring of full blood counts and adverse reactions 
related to increased rifabutin levels (e.g. uveitis) is recommended. 
 
Sirolimus 
Repeat dose administration of posaconazole oral suspension (400 mg twice daily for 16 days) 
increased the Cmax  and AUC of sirolimus (2 mg single dose) an average of 6.7-fold and 8.9-fold (range 
3.1 to 17.5-fold), respectively, in healthy subjects. The effect of posaconazole on sirolimus in patients 
is unknown, but is expected to be variable due to the variable posaconazole exposure in patients. Co- 
administration of posaconazole with sirolimus is not recommended and should be avoided whenever 
possible. If it is considered that co-administration is unavoidable, then it is recommended that the dose 
of sirolimus should be greatly reduced at the time of initiation of posaconazole therapy and that there 
should be very frequent monitoring of trough concentrations of sirolimus in whole blood. Sirolimus 
concentrations should be measured upon initiation, during co-administration, and at discontinuation of 
posaconazole treatment, with sirolimus doses adjusted accordingly. It should be noted that the 
relationship between sirolimus trough concentration and AUC is changed during co- administration 
with posaconazole. As a result, sirolimus trough concentrations that fall within the usual therapeutic 
range may result in sub-therapeutic levels. Therefore, trough concentrations that fall in the upper part 



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of the usual therapeutic range should be targeted and careful attention should be paid to clinical signs 
and symptoms, laboratory parameters and tissue biopsies. 
 
Ciclosporin 
In heart transplant patients on stable doses of ciclosporin, posaconazole oral suspension 200 mg once 
daily increased ciclosporin concentrations requiring dose reductions. Cases of elevated ciclosporin 
levels resulting in serious adverse reactions, including nephrotoxicity and one fatal case of 
leukoencephalopathy, were reported in clinical efficacy studies. When initiating treatment with 
posaconazole in patients already receiving ciclosporin, the dose of ciclosporin should be reduced (e.g. 
to about three quarters of the current dose). Thereafter blood levels of ciclosporin should be monitored 
carefully during co-administration, and upon discontinuation of posaconazole treatment, and the dose 
of ciclosporin should be adjusted as necessary. 
 
Tacrolimus 
Posaconazole increased Cmax and AUC of tacrolimus (0.05 mg/kg body weight single dose) by 121 % 
and 358 %, respectively. Clinically significant interactions resulting in hospitalisation and/or 
posaconazole discontinuation were reported in clinical efficacy studies. When initiating posaconazole 
treatment in patients already receiving tacrolimus, the dose of tacrolimus should be reduced (e.g. to 
about one third of the current dose). Thereafter blood levels of tacrolimus should be monitored 
carefully during co-administration, and upon discontinuation of posaconazole, and the dose of 
tacrolimus should be adjusted as necessary. 
 
HIV Protease inhibitors 
As HIV protease inhibitors are CYP3A4 substrates, it is expected that posaconazole will increase 
plasma levels of these antiretroviral agents. Following co-administration of posaconazole oral 
suspension (400 mg twice daily) with atazanavir (300 mg once daily) for 7 days in healthy subjects 
Cmax and AUC of atazanavir increased by an average of 2.6-fold and 3.7-fold (range 1.2 to 26-fold), 
respectively. Following co-administration of posaconazole oral suspension (400 mg twice daily) with 
atazanavir and ritonavir (300/100 mg once daily) for 7 days in healthy subjects Cmax and AUC of 
atazanavir increased by an average of 1.5-fold and 2.5-fold (range 0.9 to 4.1-fold), respectively. The 
addition of posaconazole to therapy with atazanavir or with atazanavir plus ritonavir was associated 
with increases in plasma bilirubin levels. Frequent monitoring for adverse reactions and toxicity 
related to antiretroviral agents that are substrates of CYP3A4 is recommended during 
co-administration with posaconazole. 
 
Midazolam and other benzodiazepines metabolised by CYP3A4 
In a study in healthy volunteers posaconazole oral suspension (200 mg once daily for 10 days) 
increased the exposure (AUC) of intravenous midazolam (0.05 mg/kg) by 83 %. In another study in 
healthy volunteers, repeat dose administration of posaconazole oral suspension (200 mg twice daily 
for 7 days) increased the Cmax and AUC of intravenous midazolam (0.4 mg single dose) by an average 
of 1.3- and 4.6-fold (range 1.7 to 6.4-fold), respectively; Posaconazole oral suspension 400 mg twice 
daily for 7 days increased the intravenous midazolam Cmax and AUC by 1.6 and 6.2-fold (range 1.6 to 
7.6-fold), respectively. Both doses of posaconazole increased Cmax and AUC of oral midazolam (2 mg 
single oral dose) by 2.2 and 4.5-fold, respectively. In addition, posaconazole oral suspension (200 mg 
or 400 mg) prolonged the mean terminal half-life of midazolam from approximately 3-4 hours to 
8-10 hours during co-administration. 
Due to the risk of prolonged sedation it is recommended that dose adjustments should be considered 
when posaconazole is administered concomitantly with any benzodiazepine that is metabolised by 
CYP3A4 (e.g. midazolam, triazolam, alprazolam) (see section 4.4). 
 
Calcium channel blockers metabolised through CYP3A4 (e.g. diltiazem, verapamil, nifedipine, 
nisoldipine) 
Frequent monitoring for adverse reactions and toxicity related to calcium channel blockers is 
recommended during co-administration with posaconazole. Dose adjustment of calcium channel 
blockers may be required. 
 



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Digoxin 
Administration of other azoles has been associated with increases in digoxin levels. Therefore, 
posaconazole may increase plasma concentration of digoxin and digoxin levels need to be monitored 
when initiating or discontinuing posaconazole treatment. 
 
Sulfonylureas 
Glucose concentrations decreased in some healthy volunteers when glipizide was co-administered 
with posaconazole. Monitoring of glucose concentrations is recommended in diabetic patients. 
 
Paediatric population 
 
Interaction studies have only been performed in adults. 
 
4.6 Fertility, pregnancy and lactation 
 
Pregnancy 
 
There is insufficient information on the use of posaconazole in pregnant women. Studies in animals 
have shown reproductive toxicity (see section 5.3). The potential risk for humans is unknown. 
 
Women of childbearing potential have to use effective contraception during treatment. Posaconazole 
must not be used during pregnancy unless the benefit to the mother clearly outweighs the potential risk 
to the foetus. 
 
Breast-feeding 
 
Posaconazole is excreted into the milk of lactating rats (see section 5.3). The excretion of 
posaconazole in human breast milk has not been investigated. Breast-feeding must be stopped on 
initiation of treatment with posaconazole.  
 
Fertility 
 
Posaconazole had no effect on fertility of male rats at doses up to 180 mg/kg (1.7 times the 400 mg 
twice daily regimen based on steady-state plasma concentrations in healthy volunteers) or female rats 
at a dose up to 45 mg/kg (2.2 times the 400-mg twice daily regimen). There is no clinical experience 
assessing the impact of posaconazole on fertility in humans. 
 
4.7 Effects on ability to drive and use machines 
 
Since certain adverse reactions (e.g. dizziness, somnolence, etc.) have been reported with 
posaconazole use, which potentially may affect driving/operating machinery, caution needs to be used. 
 
4.8 Undesirable effects 
 
Summary of the safety profile 
 
The safety of posaconazole oral suspension has been assessed in > 2,400 patients and healthy 
volunteers enrolled in clinical trials and from post-marketing experience. The most frequently reported 
serious related adverse reactions included nausea, vomiting, diarrhoea, pyrexia, and increased 
bilirubin. 
The safety of posaconazole tablet has been assessed in 336 patients and healthy volunteers enrolled in 
clinical trials. The safety profile of tablets was similar to that of the oral suspension. 
 



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Tabulated list of adverse reactions 
 
Within the organ system classes, adverse reactions are listed under headings of frequency using the 
following categories: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to 
<1/100); rare (≥ 1/10,000 to <1/1,000); very rare (<1/10,000); not known. 
 
Table 2. Adverse reactions by body system and frequency* 

Blood and lymphatic system disorders 
Common: neutropenia 
Uncommon: thrombocytopenia, leukopenia, anaemia, eosinophilia, 

lymphadenopathy, splenic infarction 
Rare: haemolytic uraemic syndrome, thrombotic 

thrombocytopenic purpura, pancytopenia, coagulopathy, 
haemorrhage 

Immune system disorders 
Uncommon: allergic reaction 
Rare: hypersensitivity reaction 
Endocrine disorders 
Rare: adrenal insufficiency, blood gonadotropin decreased 
Metabolism and nutrition disorders 
Common: electrolyte imbalance, anorexia, decreased appetite, 

hypokalaemia, hypomagnesaemia 
Uncommon: hyperglycaemia, hypoglycaemia 
Psychiatric disorders 
Uncommon: abnormal dreams, confusional state, sleep disorder 
Rare: psychotic disorder, depression 
Nervous system disorders 
Common: paresthesia, dizziness, somnolence, headache, dysgeusia 
Uncommon: convulsions, neuropathy, hypoaesthesia, tremor, aphasia, 

insomnia 
Rare: cerebrovascular accident, encephalopathy, peripheral 

neuropathy, syncope 
Eye disorders 
Uncommon: blurred vision, photophobia, visual acuity reduced 
Rare: diplopia, scotoma 
Ear and labyrinth disorder 
Rare: hearing impairment 
Cardiac disorders 
Uncommon: long QT syndrome§, electrocardiogram abnormal§, 

palpitations, bradycardia, supraventricular extrasystoles, 
tachycardia 

Rare: torsade de pointes, sudden death, ventricular tachycardia, 
cardio-respiratory arrest, cardiac failure, myocardial 
infarction 

Vascular disorders 
Common: hypertension 
Uncommon: hypotension, vasculitis 
Rare: pulmonary embolism, deep vein thrombosis 
Respiratory, thoracic and mediastinal disorders 
Uncommon: cough, epistaxis, hiccups, nasal congestion, pleuritic pain, 

tachypnoea 
Rare: pulmonary hypertension, interstitial pneumonia, 

pneumonitis 
Gastrointestinal disorders 
Very Common: nausea 
Common: vomiting, abdominal pain, diarrhoea, dyspepsia, dry mouth, 



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flatulence, constipation, anorectal discomfort 
Uncommon: pancreatitis, abdominal distension, enteritis, epigastric 

discomfort, eructation, gastrooesophageal reflux disease, 
oedema mouth 

Rare: gastrointestinal haemorrhage, ileus 
Hepatobiliary disorders 
Common: liver function tests raised (ALT increased, AST increased, 

bilirubin increased, alkaline phosphatase increased, GGT 
increased) 

Uncommon: hepatocellular damage, hepatitis, jaundice, hepatomegaly, 
cholestasis, hepatic toxicity, hepatic function abnormal 

Rare: hepatic failure, hepatitis cholestatic, hepatosplenomegaly, 
liver tenderness, asterixis 

Skin and subcutaneous tissue disorders 
Common: rash, pruritis 
Uncommon: mouth ulceration, alopecia, dermatitis, erythema, petechiae 
Rare: Stevens Johnson syndrome, vesicular rash 
Musculoskeletal and connective tissue disorders 
Uncommon: back pain, neck pain, musculoskeletal pain, pain in 

extremity 
Renal and urinary disorders 
Uncommon: acute renal failure, renal failure, blood creatinine increased 
Rare: renal tubular acidosis, interstitial nephritis 
Reproductive system and breast disorders 
Uncommon: menstrual disorder 
Rare: breast pain 
General disorders and administration site conditions 
Common: pyrexia (fever), asthenia, fatigue 
Uncommon: oedema, pain, chills, malaise, chest discomfort, drug 

intolerance, feeling jittery, mucosal inflammation 
Rare: tongue oedema, face oedema 
Investigations 
Uncommon: altered medicine levels, blood phosphorus decreased, chest 

x-ray abnormal 
*  Based on adverse reactions observed with the oral suspension, gastro-resistant tablets, and 

concentrate for solution for infusion. 
§ See section 4.4. 

 
Description of selected adverse reactions 
 
Hepatobiliary disorders 
During post-marketing surveillance of posaconazole oral suspension, severe hepatic injury with fatal 
outcome has been reported (see section 4.4). 
 
Reporting of suspected adverse reactions 
 
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It 
allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare 
professionals are asked to report any suspected adverse reactions via the national reporting system 
listed in Appendix V. 
 
4.9 Overdose 
 
During clinical trials, patients who received posaconazole oral suspension doses up to 1,600 mg/day 
experienced no different adverse reactions from those reported with patients at the lower doses. 

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Accidental overdose was noted in one patient who took posaconazole oral suspension 1,200 mg twice 
a day for 3 days. No adverse reactions were noted by the investigator. 
 
Posaconazole is not removed by haemodialysis. There is no special treatment available in the case of 
overdose with posaconazole. Supportive care may be considered. 
 
 
5. PHARMACOLOGICAL PROPERTIES 
 
5.1  Pharmacodynamic properties 
 
Pharmacotherapeutic group: Antimycotics for systemic use, triazole derivatives, ATC code: J02AC04. 
 
Mechanism of action 
 
Posaconazole inhibits the enzyme lanosterol 14α-demethylase (CYP51), which catalyses an essential 
step in ergosterol biosynthesis. 
 
Microbiology 
 
Posaconazole has been shown in vitro to be active against the following microorganisms: Aspergillus 
species (Aspergillus fumigatus, A. flavus, A. terreus, A. nidulans, A. niger, A. ustus), Candida species 
(Candida albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis, C. dubliniensis, C. famata, C. 
inconspicua, C. lipolytica, C. norvegensis, C. pseudotropicalis), Coccidioides immitis, Fonsecaea 
pedrosoi, and species of Fusarium, Rhizomucor, Mucor, and Rhizopus. The microbiological data 
suggest that posaconazole is active against Rhizomucor, Mucor, and Rhizopus; however the clinical 
data are currently too limited to assess the efficacy of posaconazole against these causative agents. 
 
Resistance 
 
Clinical isolates with decreased susceptibility to posaconazole have been identified. The principle 
mechanism of resistance is the acquisition of substitutions in the target protein, CYP51. 
 
Epidemiological Cut-off (ECOFF) Values for Aspergillus spp. 
 
The ECOFF values for posaconazole, which distinguish the wild type population from isolates with 
acquired resistance, have been determined by EUCAST methodology. 
 
EUCAST ECOFF values: 
- Aspergillus flavus: 0.5 mg/L 
- Aspergillus fumigatus: 0.25 mg/L 
- Aspergillus nidulans: 0.5 mg/L 
- Aspergillus niger: 0.5 mg/L 
- Aspergillus terreus: 0.25 mg/L 
 
There are currently insufficient data to set clinical breakpoints for Aspergillus spp. ECOFF values do 
not equate to clinical breakpoints. 
 
Breakpoints 
 
EUCAST MIC breakpoints for posaconazole [susceptible (S); resistant (R)]: 
- Candida albicans: S ≤0.06 mg/L, R >0.06 mg/L 
- Candida tropicalis: S ≤0.06 mg/L, R >0.06 mg/L 
- Candida parapsilosis: S ≤0.06 mg/L, R >0.06 mg/L 
 
There are currently insufficient data to set clinical breakpoints for other Candida species. 
 



13 

Combination with other antifungal agents 
 
The use of combination antifungal therapies should not decrease the efficacy of either posaconazole or 
the other therapies; however, there is currently no clinical evidence that combination therapy will 
provide an added benefit. 
 
Pharmacokinetic / Pharmacodynamic relationships 
A correlation between total medicinal product exposure divided by MIC (AUC/MIC) and clinical 
outcome was observed. The critical ratio for subjects with Aspergillus infections was ~200. It is 
particularly important to try to ensure that maximal plasma levels are achieved in patients infected 
with Aspergillus (see sections 4.2 and 5.2 on recommended dose regimens and the effects of food on 
absorption). 
 
Clinical experience 
 
Summary of posaconazole oral suspension studies 
 
Invasive aspergillosis 
Oral posaconazole suspension 800 mg/day in divided doses was evaluated for the treatment of 
invasive aspergillosis in patients with disease refractory to amphotericin B (including liposomal 
formulations) or itraconazole or in patients who were intolerant of these medicinal products in a non- 
comparative salvage therapy trial (Study 0041). Clinical outcomes were compared with those in an 
external control group derived from a retrospective review of medical records. The external control 
group included 86 patients treated with available therapy (as above) mostly at the same time and at the 
same sites as the patients treated with posaconazole. Most of the cases of aspergillosis were considered 
to be refractory to prior therapy in both the posaconazole group (88 %) and in the external control 
group (79 %). 
 
As shown in Table 3, a successful response (complete or partial resolution) at the end of treatment was 
seen in 42 % of posaconazole-treated patients compared to 26 % of the external group. However, this 
was not a prospective, randomised controlled study and so all comparisons with the external control 
group should be viewed with caution. 
 
Table 3.    Overall efficacy of posaconazole oral suspension at the end of treatment for invasive 
aspergillosis in comparison to an external control group 
 Posaconazole oral suspension External control group 
Overall Response 45/107 (42 %) 22/86 (26 %) 
Success by Species 

All mycologically confirmed 
    Aspergillus spp.1 

 
 
34/76                 (45 %) 

 
 
19/74               (26%) 

A. fumigatus 12/29                 (41 %) 12/34               (35%) 
A. flavus 10/19                 (53 %) 3/16                 (19%) 
A. terreus 4/14                   (29 %) 2/13                 (15%) 
A. niger 3/5                     (60 %) 2/7                   (29%) 
1 Includes other less common species or species unknown 
 
Fusarium spp. 
11 of 24 patients who had proven or probable fusariosis were successfully treated with posaconazole 
oral suspension 800 mg/day in divided doses for a median of 124 days and up to 212 days. Among 
eighteen patients who were intolerant or had infections refractory to amphotericin B or itraconazole, 
seven patients were classed as responders. 
 
Chromoblastomycosis/Mycetoma 
9 of 11 patients were successfully treated with posaconazole oral suspension 800 mg/day in divided 
doses for a median of 268 days and up to 377 days. Five of these patients had chromoblastomycosis 
due to Fonsecaea pedrosoi and 4 had mycetoma, mostly due to Madurella species. 
 



14 

Coccidioidomycosis 
11 of 16 patients were successfully treated (at the end of treatment complete or partial resolution of 
signs and symptoms present at baseline) with posaconazole oral suspension 800 mg/day in divided 
doses for a median of 296 days and up to 460 days. 
 
Treatment of azole-susceptible Oropharyngeal Candidiasis (OPC) 
A randomised, evaluator-blind, controlled study was completed in HIV-infected patients with 
azolesusceptible oropharyngeal candidiasis (most patients studied had C. albicans isolated at baseline). 
The primary efficacy variable was the clinical success rate (defined as cure or improvement) after 14 
days of treatment. Patients were treated with posaconazole or fluconazole oral suspension (both 
posaconazole and fluconazole were given as follows: 100 mg twice a day for 1 day followed by 
100 mg once a day for 13 days). 
 
The clinical response rates from the above study are shown in the Table 4 below. 
Posaconazole was shown to be non-inferior to fluconazole for clinical success rates at Day 14 as well 
as 4 weeks after the end of treatment. 
 
Table 4. Clinical success rates in Oropharyngeal Candidiasis 
Endpoint Posaconazole Fluconazole 
Clinical success rate at Day 14 91.7 % (155/169) 92.5 % (148/160) 
Clinical success rate 4 weeks after end of treatment 68.5 % (98/143) 61.8 % (84/136) 
Clinical success rate was defined as the number of cases assessed as having a clinical response (cure or improvement) 
divided by the total number of cases eligible for analysis 
 
Prophylaxis of Invasive Fungal Infections (IFIs) (Studies 316 and 1899) 
Two randomised, controlled prophylaxis studies were conducted among patients at high risk for 
developing invasive fungal infections. 
 
Study 316 was a randomised, double-blind trial of posaconazole oral suspension (200 mg three times a 
day) versus fluconazole capsules (400 mg once daily) in allogeneic hematopoietic stem cell transplant 
recipients with graft-versus-host disease (GVHD). The primary efficacy endpoint was the incidence of 
proven/probable IFIs at 16 weeks post-randomization as determined by an independent, blinded 
external expert panel. A key secondary endpoint was the incidence of proven/probable IFIs during the 
on-treatment period (first dose to last dose of study medicinal product + 7 days). The majority 
(377/600, [63 %]) of patients included had Acute Grade 2 or 3 or chronic extensive (195/600, 
[32.5%]) GVHD at study start. The mean duration of therapy was 80 days for posaconazole and 77 
days for fluconazole. 
 
Study 1899 was a randomised, evaluator-blinded study of posaconazole oral suspension (200 mg three 
times a day) versus fluconazole suspension (400 mg once daily) or itraconazole oral solution (200 mg 
twice a day) in neutropenic patients who were receiving cytotoxic chemotherapy for acute 
myelogenous leukaemia or myelodysplastic syndromes. The primary efficacy endpoint was the 
incidence of proven/probable IFIs as determined by an independent, blinded external expert panel 
during the on-treatment period. A key secondary endpoint was the incidence of proven/probable IFIs 
at 100 days post-randomization. New diagnosis of acute myelogenous leukaemia was the most 
common underlying condition (435/602, [72 %]). The mean duration of therapy was 29 days for 
posaconazole and 25 days for fluconazole/itraconazole. 
 
In both prophylaxis studies, aspergillosis was the most common breakthrough infection. See Table 5 
and 6 for results from both studies. There were fewer breakthrough Aspergillus infections in patients 
receiving posaconazole prophylaxis when compared to control patients. 
 



15 

Table 5. Results from clinical studies in prophylaxis of Invasive Fungal Infections 
Study Posaconazole oral 

suspension 
Controla P-Value 

Proportion (%) of patients with proven/probable IFIs 
On-treatment periodb 

1899d 7/304 (2) 25/298 (8) 0.0009 
316e 7/291 (2) 22/288 (8) 0.0038 

Fixed-time periodc 
1899d 14/304 (5) 33/298 (11) 0.0031 
316 d 16/301 (5) 27/299 (9) 0.0740 

FLU = fluconazole; ITZ = itraconazole; POS = posaconazole.  
a:       FLU/ITZ (1899); FLU (316). 
b: In 1899 this was the period from randomization to last dose of study medicinal product plus 7 days; in 316 

it was the period from first dose to last dose of study medicinal product plus 7 days. 
c: In 1899, this was the period from randomization to 100 days post-randomization; in 316 it was the period 

from the baseline day to 111 days post-baseline. 
d:      All randomized 
e:      All treated 
 
Table 6. Results from clinical studies in prophylaxis of Invasive Fungal Infections 

Study Posaconazole oral 
suspension 

Controla 

Proportion (%) of patients with proven/probable  Aspergillosis 
On-treatment periodb 

1899d 2/304 (1) 25/298 (7) 
316e 3/291 (1) 17/288 (6) 

Fixed-time periodc 
1899d 4/304(1) 26/298 (9) 
316 d 7/301 (2) 21/299 (9) 

FLU = fluconazole; ITZ = itraconazole; POS = posaconazole. 
a:      FLU/ITZ (1899); FLU (316). 
b: In 1899 this was the period from randomization to last dose of study medicinal product plus 7 days; in 316 

it was the period from first dose to last dose of study medicinal product plus 7 days. 
c: In 1899, this was the period from randomization to 100 days post-randomization; in 316 it was the period 

from the baseline day to 111 days post-baseline. 
d:      All randomized 
e:      All treated 
 
In Study 1899, a significant decrease in all cause mortality in favour of posaconazole was observed 
[POS 49/304 (16 %) vs. FLU/ITZ 67/298 (22 %) p= 0.048]. Based on Kaplan-Meier estimates, the 
probability of survival up to day 100 after randomization, was significantly higher for posaconazole 
recipients; this survival benefit was demonstrated when the analysis considered all causes of death (P= 
0.0354) as well as IFI-related deaths (P = 0.0209). 
 
In Study 316, overall mortality was similar (POS, 25 %; FLU, 28 %); however, the proportion of IFI- 
related deaths was significantly lower in the POS group (4/301) compared with the FLU group 
(12/299; P= 0.0413). 
 
Paediatric population 
 
Sixteen patients 8-17 years of age were treated with posaconazole oral suspension 800 mg/day in a 
study for invasive fungal infections (Study 0041). Based on the available data in 16 of these paediatric 
patients, the safety profile appears to be similar to patients ≥ 18 years of age. 
 
Additionally, twelve patients 13-17 years of age received posaconazole oral suspension 600 mg/day 
for prophylaxis of invasive fungal infections (Studies 316 and 1899). The safety profile in these 
patients < 18 years of age appears similar to the safety profile observed in adults. Based on 



16 

pharmacokinetic data in 10 of these paediatric patients, the pharmacokinetic profile appears to be 
similar to patients ≥ 18 years of age. In a study (Study 03579) of 136 neutropenic paediatric patients 
11 months – 17 years treated with posaconazole oral suspension at doses up to 18 mg/kg/day divided 
TID, approximately 50% met the pre-specified target (Day 7 Cav between 500 ng/mL-2,500 ng/mL) 
(see section 5.2). 
 
Safety and efficacy in paediatric patients below the age of 18 years have not been established.  
 
Electrocardiogram evaluation 
 
Multiple, time-matched ECGs collected over a 12 hour period were obtained before and during 
administration of posaconazole oral suspension (400 mg twice daily with high fat meals) from 173 
healthy male and female volunteers aged 18 to 85 years. No clinically relevant changes in the mean 
QTc (Fridericia) interval from baseline were observed. 
 
5.2 Pharmacokinetic properties 
 
Absorption 
 
Posaconazole is absorbed with a median tmax of 3 hours (fed patients). The pharmacokinetics of 
posaconazole are linear following single and multiple dose administration of up to 800 mg when taken 
with a high fat meal. No further increases in exposure were observed when doses above 800 mg daily 
were administered to patients and healthy volunteers. In the fasting state, AUC increased less than in 
proportion to dose above 200 mg. In healthy volunteers under fasting conditions, dividing the total 
daily dose (800 mg) into 200 mg four times daily compared to 400 mg twice daily, was shown to 
increase posaconazole exposure by 2.6-fold. 
 
Effect of food on oral absorption in healthy volunteers 
 
The absorption of posaconazole was significantly increased when posaconazole 400 mg (once daily) 
was administered during and immediately after the consumption of a high fat meal (~ 50 grams fat) 
compared to administration before a meal, with Cmax and AUC increasing by approximately 330 % and 
360 %, respectively. The AUC of posaconazole is: 4 times greater when administered with a high fat 
meal (~ 50 grams fat) and about 2.6 times greater when administered during a non-fat meal or 
nutritional supplement (14 grams fat) relative to the fasted state (see sections 4.2 and 4.5). 
 
Distribution 
 
Posaconazole is slowly absorbed and slowly eliminated with a large apparent volume of distribution 
(1,774 litres) and is highly protein bound (> 98 %), predominantly to serum albumin. 
 
Biotransformation 
 
Posaconazole does not have any major circulating metabolites and its concentrations are unlikely to 
be altered by inhibitors of CYP450 enzymes. Of the circulating metabolites, the majority are 
glucuronide conjugates of posaconazole with only minor amounts of oxidative (CYP450 mediated) 
metabolites observed. The excreted metabolites in urine and faeces account for approximately 17 % 
of the administered radiolabelled dose. 
 
Elimination 
 
Posaconazole is slowly eliminated with a mean half-life (t½) of 35 hours (range 20 to 66 hours). After 
administration of 14C-posaconazole, radioactivity was predominantly recovered in the faeces (77 % of 
the radiolabelled dose) with the major component being parent compound (66 % of the radiolabelled 
dose). Renal clearance is a minor elimination pathway, with 14 % of the radiolabelled dose excreted in 
urine (< 0.2 % of the radiolabelled dose is parent compound). Steady-state is attained following 
7 to 10 days of multiple-dose administration. 



17 

 
Pharmacokinetics in special populations 
 
Children (< 18 years) 
Following administration of 800 mg per day of posaconazole as a divided dose for treatment of 
invasive fungal infections, mean trough plasma concentrations from 12 patients 8 - 17 years of age 
(776 ng/mL) were similar to concentrations from 194 patients 18 - 64 years of age (817 ng/mL). 
Similarly, in the prophylaxis studies, the mean steady-state posaconazole average concentration (Cav) 
was comparable among ten adolescents (13-17 years of age) to Cav achieved in adults (≥ 18 years of 
age). In a study of 136 neutropenic paediatric patients 11 months – 17 years treated with posaconazole 
oral suspension at doses up to 18 mg/kg/day divided TID, approximately 50% met the pre-specified 
target (Day 7 Cav between 500 ng/mL-2,500 ng/mL). In general, exposures tended to be higher in the 
older patients (7 to <18 years) than in younger patients (2 to <7 years). 
 
Gender 
The pharmacokinetics of posaconazole are comparable in men and women. 
 
Elderly (≥ 65 years) 
An increase in Cmax (26 %) and AUC (29 %) was observed in elderly subjects (24 subjects ≥ 65 years 
of age) relative to younger subjects (24 subjects 18 - 45 years of age). However, in clinical efficacy 
trials, the safety profile of posaconazole between the young and elderly patients was similar. 
 
Race 
There was a slight decrease (16 %) in the AUC and Cmax of posaconazole oral suspension in Black 
subjects relative to Caucasian subjects. However, the safety profile of posaconazole between the Black 
and Caucasian subjects was similar. 
 
Weight 
Pharmacokinetic modeling with an oral tablet formulation suggests that patients weighing greater than 
120 kg may have lower posaconazole exposure. It is, therefore, suggested to closely monitor for 
breakthrough fungal infections in patients weighing more than 120 kg. Patients with a low body 
weight (< 60 kg) are more likely to experience higher plasma concentrations of posaconazole and 
should be closely monitored for adverse events. 
 
Renal impairment 
Following single-dose administration of posaconazole oral suspension, there was no effect of mild and 
moderate renal impairment (n=18, Cl cr ≥ 20 mL/min/1.73 m2) on posaconazole pharmacokinetics; 
therefore, no dose adjustment is required. In subjects with severe renal impairment (n=6, Cl cr< 20 
mL/min/1.73 m2), the AUC of posaconazole was highly variable [> 96 % CV (coefficient of variance)] 
compared to other renal groups [< 40 % CV]. However, as posaconazole is not significantly renally 
eliminated, an effect of severe renal impairment on the pharmacokinetics of posaconazole is not 
expected and no dose adjustment is recommended. Posaconazole is not removed by haemodialysis. 
 
Hepatic impairment 
After a single oral dose of 400 mg posaconazole oral suspension to patients with mild (Child-Pugh 
Class A), moderate (Child-Pugh Class B) or severe (Child-Pugh Class C) hepatic impairment (six per 
group), the mean AUC was 1.3 to 1.6-fold higher compared to that for matched control subjects with 
normal hepatic function. Unbound concentrations were not determined and it cannot be excluded that 
there is a larger increase in unbound posaconazole exposure than the observed 60 % increase in total 
AUC. The elimination half-life (t1/2) was prolonged from approximately 27 hours up to ~43 hours in 
respective groups. No dose adjustment is recommended for patients with mild to severe hepatic 
impairment but caution is advised due to the potential for higher plasma exposure. 
 
5.3 Preclinical safety data 
 
As observed with other azole antifungal agents, effects related to inhibition of steroid hormone 
synthesis were seen in repeated-dose toxicity studies with posaconazole. Adrenal suppressive effects 



18 

were observed in toxicity studies in rats and dogs at exposures equal to or greater than those obtained 
at therapeutic doses in humans. 
 
Neuronal phospholipidosis occurred in dogs dosed for ≥ 3 months at lower systemic exposures than 
those obtained at therapeutic doses in humans. This finding was not seen in monkeys dosed for one 
year. In twelve-month neurotoxicity studies in dogs and monkeys, no functional effects were observed 
on the central or peripheral nervous systems at systemic exposures greater than those achieved 
therapeutically. 
 
Pulmonary phospholipidosis resulting in dilatation and obstruction of the alveoli was observed in the 
2-year study in rats. These findings are not necessarily indicative of a potential for functional changes 
in humans. 
 
No effects on electrocardiograms, including QT and QTc intervals, were seen in a repeat dose safety 
pharmacology study in monkeys at systemic exposures 4.6-fold greater than the concentrations 
obtained at therapeutic doses in humans. Echocardiography revealed no indication of cardiac 
decompensation in a repeat dose safety pharmacology study in rats at a systemic exposure 1.4-fold 
greater than that achieved therapeutically. Increased systolic and arterial blood pressures (up to 
29 mm-Hg) were seen in rats and monkeys at systemic exposures 1.4-fold and 4.6-fold greater, 
respectively, than those achieved with the human therapeutic doses. 
 
Reproduction, peri- and postnatal development studies were conducted in rats. At exposures lower 
than those obtained at therapeutic doses in humans, posaconazole caused skeletal variations and 
malformations, dystocia, increased length of gestation, reduced mean litter size and postnatal viability. 
In rabbits, posaconazole was embryotoxic at exposures greater than those obtained at therapeutic 
doses. As observed with other azole antifungal agents, these effects on reproduction were considered 
to be due to a treatment-related effect on steroidogenesis. 
 
Posaconazole was not genotoxic in in vitro and in vivo studies. Carcinogenicity studies did not reveal 
special hazards for humans. 
 
 
6. PHARMACEUTICAL PARTICULARS 
 
6.1 List of excipients 
 
Macrogolglycerol hydroxystearate 
Sodium citrate dihydrate 
Citric acid monohydrate 
Simeticone emulsion (containing polydimethylsiloxane, polyethylene glycol sorbitan tristearate, 
methylcellulose, silica gel, polyethylene glycol stearate, sorbic acid (E200), benzoic acid (E210) and 
sulfuric acid (E513)) 
Xanthan gum (E415) 
Sodium benzoate (E211) 
Liquid glucose 
Glycerol (E422) 
Titanium dioxide (E171) 
Strawberry flavour (containing propylene glycol) 
Purified water 
 
6.2 Incompatibilities 
 
Not applicable. 
 



19 

6.3 Shelf life 
 
30 months 
After first opening the container: 30 days 
 
6.4 Special precautions for storage 
 
This medicinal product does not require any special storage conditions. 
 
6.5 Nature and contents of container  
 
The primary packaging is an amber glass bottle (Type III) closed with a child-resistant and tamper 
evident polypropylene cap. The filled and sealed bottle is packed into a carton along with a graduated 
polystyrene spoon (2.5 mL and 5 mL) for dispensing and administration of the suspension. 
 
6.6 Special precautions for disposal  
 
No special requirements 
 
 
7. MARKETING AUTHORISATION HOLDER 
 
Accord Healthcare S.L.U. 
World Trade Center, Moll de Barcelona s/n,  
Edifici Est, 6a planta, Barcelona, 
08039 Barcelona, Spain 
 
 
8. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/19/1380/001 
 
 
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 
 
Date of first authorisation: 
 
 
10. DATE OF REVISION OF THE TEXT 
 
Detailed information on this product is available on the website of the European Medicines Agency 
http://www.ema.europa.eu  
 

http://www.ema.europa.eu/


20 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX II 
 

A. MANUFACTURERS RESPONSIBLE FOR BATCH RELEASE 
 

B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE 
 

C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 
AUTHORISATION 

 
D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE 

AND EFFECTIVE USE OF THE MEDICINAL PRODUCT 



21 

A. MANUFACTURER(S) RESPONSIBLE FOR BATCH RELEASE 
 
Name and address of the manufacturer(s) responsible for batch release 
 
Accord Healthcare Limited 
Sage House 
319 Pinner Road 
North Harrow 
Middlesex  
HA1 4HF 
UNITED KINGDOM 
 
Accord Healthcare Polska Sp. z o.o. 
ul. Lutomierska 50 
95-200 Pabianice 
POLAND 
 
Laboratori Fundacio Dau 
C/ C, 12-14 Pol. Ind. Zona Franca 
08040 Barcelona 
SPAIN 
 
Pharmadox Healthcare Ltd. 
KW20A Kordin Industrial Park 
Paola, PLA 3000 
MALTA 
 
Wessling Hungary Kft. 
Anomymus u 6 
H-1045 Budapest 
HUNGARY 
 
The printed package leaflet of the medicinal product must state the name and address of the 
manufacturer responsible for the release of the concerned batch. 
 
 
B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE  
 
Medicinal product subject to restricted medical prescription (see Annex I: Summary of Product 
Characteristics, section 4.2). 
 
 
C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING 

AUTHORISATION 
 
● Periodic Safety Update Reports 
 
The requirements for submission of periodic safety update reports for this medicinal product are 
set out in the list of Union reference dates (EURD list) provided for under Article 107c(7) of 
Directive 2001/83/EC and any subsequent updates published on the European medicines web-
portal. 
 
 



22 

D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND 
EFFECTIVE USE OF THE MEDICINAL PRODUCT 

 
● Risk Management Plan (RMP) 
 
The MAH shall perform the required pharmacovigilance activities and interventions detailed in the 
agreed RMP presented in Module 1.8.2 of the Marketing Authorisation and any agreed subsequent 
updates of the RMP. 
 
An updated RMP should be submitted: 
 ● At the request of the European Medicines Agency; 

● Whenever the risk management system is modified, especially as the result of new 
information being received that may lead to a significant change to the benefit/risk profile 
or as the result of an important (pharmacovigilance or risk minimisation) milestone being 
reached. 



23 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

ANNEX III 
 

LABELLING AND PACKAGE LEAFLET 



24 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

A. LABELLING 



25 

 
PARTICULARS TO APPEAR ON THE OUTER PACKAGING  
 
OUTER CARTON 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Posaconazole AHCL 40 mg/mL oral suspension  
posaconazole 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE(S) 
 
Each mL contains 40 mg of posaconazole. 
 
 
3. LIST OF EXCIPIENTS 
 
Contains glucose. 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Oral suspension 
105 mL 
Measuring spoon 
 
 
5. METHOD AND ROUTE(S) OF ADMINISTRATION 
 
Read the package leaflet before use. 
Shake well before use. 
Oral use. 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children. 
 
 
7. OTHER SPECIAL WARNING(S), IF NECESSARY 
 
Posaconazole oral suspension and posaconazole tablets are NOT interchangeable. 
 
 
8. EXPIRY DATE 
 
EXP 
Discard after 30 days of opening. 
Opening date:_________ 
 
 



26 

9. SPECIAL STORAGE CONDITIONS 
 
 
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 

OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Accord Healthcare S.L.U. 
World Trade Center, Moll de Barcelona s/n,  
Edifici Est, 6a planta, Barcelona, 
08039 Barcelona, Spain 
 
 
12. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/19/1380/001 
 
 
13. BATCH NUMBER 
 
Lot 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
Posaconazole AHCL 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
2D barcode carrying the unique identifier included. 
 
 
18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 
 
PC:  
SN: 
NN:  



27 

 
PARTICULARS TO APPEAR ON THE IMMEDIATE PACKAGING 
 
BOTTLE LABEL 
 
 
1. NAME OF THE MEDICINAL PRODUCT 
 
Posaconazole AHCL 40 mg/mL oral suspension  
posaconazole 
 
 
2. STATEMENT OF ACTIVE SUBSTANCE(S) 
 
Each mL contains 40 mg of posaconazole. 
 
 
3. LIST OF EXCIPIENTS 
 
Contains glucose. 
 
 
4. PHARMACEUTICAL FORM AND CONTENTS 
 
Oral suspension 
105 mL  
 
 
5. METHOD AND ROUTE(S) OF ADMINISTRATION 
 
Read the package leaflet before use. 
Shake well before use. 
Oral use. 
 
 
6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT 

OF THE SIGHT AND REACH OF CHILDREN 
 
Keep out of the sight and reach of children. 
 
 
7. OTHER SPECIAL WARNING(S), IF NECESSARY 
 
 
8. EXPIRY DATE 
 
EXP 
Discard after 30 days of opening. 
 
 
9. SPECIAL STORAGE CONDITIONS 
 
 



28 

10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL PRODUCTS 
OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL PRODUCTS, IF 
APPROPRIATE 

 
 
11. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER 
 
Accord Healthcare S.L.U. 
 
 
12. MARKETING AUTHORISATION NUMBER(S)  
 
EU/1/19/1380/001 
 
 
13. BATCH NUMBER 
 
Lot 
 
 
14. GENERAL CLASSIFICATION FOR SUPPLY 
 
 
15. INSTRUCTIONS ON USE 
 
 
16. INFORMATION IN BRAILLE 
 
 
17. UNIQUE IDENTIFIER – 2D BARCODE 
 
 
18. UNIQUE IDENTIFIER - HUMAN READABLE DATA 
 
 



29 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

B. PACKAGE LEAFLET 



30 

Package leaflet: Information for the user 
 

Posaconazole AHCL 40 mg/mL oral suspension 
posaconazole 

 
Read all of this leaflet carefully before you start taking this medicine because it contains 
important information for you. 
• Keep this leaflet. You may need to read it again. 
• If you have any further questions, ask your doctor, pharmacist or nurse. 
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, 

even if their signs of illness are the same as yours. 
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side 

effects not listed in this leaflet. See section 4. 
 
What is in this leaflet 
1. What Posaconazole AHCL is and what it is used for 
2. What you need to know before you take Posaconazole AHCL 
3. How to take Posaconazole AHCL 
4. Possible side effects 
5. How to store Posaconazole AHCL 
6. Contents of the pack and other information 
 
 
1. What Posaconazole AHCL is and what it is used for 
 
Posaconazole AHCL 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 AHCL 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 

leukemia” (AML) or “myelodysplastic syndromes” (MDS) 
- patients having “high- dose immunosuppressive therapy” after “hematopoietic stem cell 

transplant” (HSCT). 
 



31 

2. What you need to know before you take Posaconazole AHCL 
 
Do not take Posaconazole AHCL 
- if you are allergic to posaconazole or any of the other ingredients of this medicine (listed in 

section 6). 
- if 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 

 
Do not take Posaconazole AHCL if any of the above apply to you. If you are not sure, talk to your 
doctor or pharmacist before taking Posaconazole AHCL. 
 
See “Other medicines and Posaconazole AHCL” below for more information including information on 
other medicines which may interact with Posaconazole AHCL. 
 
Warnings and precautions 
Talk to your doctor or pharmacist before taking Posaconazole AHCL 
- if you have had an allergic reaction to another antifungal medicine such as ketoconazole, 

fluconazole, itraconazole or voriconazole. 
- if you have or have ever had liver problems. You may need to have blood tests while you are 

taking this medicine. 
- if you develop severe diarrhoea or vomiting, as these conditions may limit the effectiveness of 

this medicine. 
- if you have an abnormal heart rhythm tracing (ECG) that shows a problem called long QTc 

interval 
- if you have a weakness of the heart muscle or heart failure 
- if you have a very slow heartbeat 
- if you have heart rhythm disturbance 
- if you have any problem with potassium, magnesium or calcium levels in your blood 
- if you are taking vincristine, vinblastine and other “vinca alkaloids” (medicines 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 AHCL. 
 
If you develop severe diarrhoea or vomiting (being sick) while taking Posaconazole AHCL, 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 AHCL should not be used in children (17 years of age and younger). 
 
Other medicines and Posaconazole AHCL 
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other 
medicines. 
 
Do not take Posaconazole AHCL 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). 
 



32 

Posaconazole AHCL 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 AHCL 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. 
 
Do not take Posaconazole AHCL 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 
AHCL. 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 AHCL. 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 AHCL by increasing the 
amount of Posaconazole AHCL in the blood. 
 
The following medicines may decrease the effectiveness of Posaconazole AHCL by decreasing the 
amount of Posaconazole AHCL 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. 
 
Posaconazole AHCL 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) 
- 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). 
 
If any of the above apply to you (or you are not sure), talk to your doctor or pharmacist before taking 
Posaconazole AHCL. 
 
Posaconazole AHCL 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 AHCL”). There is no 
information on the effect of alcohol on posaconazole." 
 



33 

Pregnancy and breast-feeding 
Tell your doctor if you are or think you are pregnant before you start to take Posaconazole AHCL. 
Do not take Posaconazole AHCL 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 AHCL, contact your 
doctor straight away. 
 
Do not breast-feed while taking Posaconazole AHCL. 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 AHCL, 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 AHCL contains glucose 
Posaconazole AHCL contains approximately 1.75g of glucose per 5mLof 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. 
 
This medicine contains less than 1 mmol sodium (23 mg) per 5 mL of suspension, that is to say 
essentially ‘sodium-free’. 
 
 
3. How to take Posaconazole AHCL 
 
Do not switch between taking Posaconazole tablets and posaconazole 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 AHCL 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 during or immediately after food or a nutritional 
drink. 
 
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. 

 



34 

If you take more Posaconazole AHCL 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 AHCL 
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 



35 

- 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 (pleurritic 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 



36 

- 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 (hemolysis) 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 
 
Some patients have also reported feeling confused after taking Posaconazole AHCL, the frequency of 
this is not known. 
 
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 national reporting 
system listed in Appendix V. By reporting side effects you can help provide more information on the 
safety of this medicine.  
 
 
5. How to store Posaconazole AHCL 
 
- 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. The expiry date refers 

to the last day of that month. 
- This medicinal product does not require any special storage conditions. 
- If you have any suspension left in a bottle more than 30 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 AHCL contains 
The active substance is posaconazole. Each millilitre of oral suspension contains 40 milligrams of 
posaconazole. 
 
The other ingredients in the suspension are macrogolglycerol hydroxystearate, sodium citrate 
dihydrate, citric acid monohydrate, simeticone emulsion (containing polydimethylsiloxane, 
polyethylene glycol sorbitan tristearate, methylcellulose, silica gel, polyethylene glycol stearate, sorbic 
acid (E200), benzoic acid (E210) and sulfuric acid (E513)), xanthan gum (E415), sodium benzoate 
(E211), liquid glucose, glycerol (E422), titanium dioxide (E171), strawberry flavour (containing 
propylene glycol) and purified water. 

http://www.ema.europa.eu/docs/en_GB/document_library/Template_or_form/2013/03/WC500139752.doc


37 

 
What Posaconazole AHCL looks like and contents of the pack 
Posaconazole AHCL is a white to off-white free flowing suspension, packaged in amber glass bottle. 
A measuring spoon is provided with each bottle for measuring 2.5 and 5 mL doses of the oral 
suspension. 
 
Marketing Authorisation Holder 
Accord Healthcare S.L.U. 
World Trade Center, Moll de Barcelona s/n,  
Edifici Est, 6a planta, Barcelona, 
08039 Barcelona, Spain 
 
Manufacturer 
Accord Healthcare Limited 
Sage House, 319 Pinner Road 
North Harrow, Middlesex, HA1 4HF 
United Kingdom 
 
Laboratori Fundacio Dau 
C/ C, 12-14 Pol. Ind. Zona Franca, 
08040 Barcelona, Spain 
 
Wessing Hungary Kft. 
Anonymus u 6. 
H-1045 Budapest  
Hungary 
 
Pharmadox Healthcare Ltd. 
KW20A Kordin Industrial Park 
Paola, PLA 3000 
Malta 
 
Accord Healthcare Polska Sp. z o.o. 
ul. Lutomierska 50,  
95-200 Pabianice  
Poland 
 
This leaflet was last revised in {MM/YYYY} 
 
Other sources of information 
 
Detailed information on this medicine is available on the European Medicines Agency web site: 
http://www.ema.europa.eu.  
 
 

http://www.ema.europa.eu/

	ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS
	A. MANUFACTURER(S) RESPONSIBLE FOR BATCH RELEASE
	B. CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE
	C. OTHER CONDITIONS AND REQUIREMENTS OF THE MARKETING AUTHORISATION
	D. CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND EFFECTIVE USE OF THE MEDICINAL PRODUCT
	A. LABELLING
	B. PACKAGE LEAFLET