Indications: Invasive Aspergillus and Candida infections: Suspension and delayed-release tablets (13 years and older) and injection (18 years and older): Prophylaxis of invasive Aspergillus and Candida infections in patients who are at high risk of developing these infections due to being severely immunocompromised (hematopoietic stem cell transplant [HSCT] recipients with graft-versus-host disease [GVHD] or those with prolonged neutropenia secondary to chemotherapy for hematologic malignancies).

Oropharyngeal candidiasis: Suspension (13 years and older): Treatment of oropharyngeal candidiasis (including patients refractory to itraconazole and/or fluconazole or amphotericin B (based on canadian labeling).

Cautions: cardiomyopathy, bradycardia, symptomatic arrhythmias, history of QT interval prolongation, concomitant use with other drugs known to cause QT- interval prolongation monitor electrolytes (including potassium, magnesium, and calcium) before and during therapy monitor liver function before and during therapy. body-weight under 60 kg—risk of side effects, increased; body-weight over 120 kg—risk of treatment failure possibly increased.

Contra-indications: acute porphyria. Hepatic impairment: monitor liver function; manufacturer advises caution.

Pregnancy: manufacturer advises avoid unless potential benefit outweighs risk and recommends effective contraception during treatment (shows toxicity in animal studies).

Breast-feeding: manufacturer advises avoid—present in milk in animal studies.

Side Effects: Most common: gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, diarrhoea, constipation, dyspepsia, and flatulence) dizziness, headache, paraesthesia, drowsiness, fatigue, fever, anorexia blood disorders (including anaemia, neutropenia, and thrombocytopenia), electrolyte disturbances dry mouth. rash, pruritus. less commonly:

pancreatitis hepatic disorders gastro-oesophageal reflux arrhythmias, bradycardia, tachycardia, palpitation, changes in blood pressure, oedema, vasculitis cough, hiccups, convulsions, neuropathy, tremor, aphasia, insomnia, hyperglycaemia, menstrual disorders, renal failure, musculoskeletal pain, visual disturbances, mouth ulcers, and alopecia. rarely: ileus, cardiac failure, myocardial infarction, stroke, thrombosis, syncope, pneumonitis, psychosis, depression, encephalopathy, adrenal insufficiency, breast pain, hearing impairment, and Stevens-Johnson syndrome.

Dose: ADULT over 18 years: 400 mg twice daily with food or if food not tolerated, 200 mg 4 times daily.

Oropharyngeal candidiasis (severe infection or in immunocompromised patients only). ADULT over 18 years: mg with food on first day, then 100 mg once daily with food for 13 days. Prophylaxis of invasive fungal infections in patients undergoing bone-marrow transplantation or receiving chemotherapy for acute myeloid leukaemia and myelodysplastic syndrome who are expected to become neutropenic, and who are intolerant of fluconazole or itraconazole: ADULT over 18 years: 200 mg 3 times daily with food (starting before transplantation or before chemotherapy and continued until neutrophil count recovers).

Note : Where possible, tablets should be used in preference to the suspension because the tablets have a higher bioavailability; the suspension is not interchangeable with the tablets on a milligram-for- milligram basis