From the Guidelines
Cresemba (isavuconazonium sulfate) can potentially cause pill esophagitis, though it is not among the most commonly reported side effects. Pill esophagitis occurs when a medication becomes lodged in the esophagus and causes irritation or inflammation of the esophageal lining. To minimize this risk when taking Cresemba, always take it with a full glass of water (at least 8 ounces), remain upright for at least 30 minutes after taking the medication, and avoid lying down immediately after taking it. If you experience symptoms such as painful or difficult swallowing, chest pain, or the feeling that the pill is stuck in your throat, contact your healthcare provider promptly. These symptoms could indicate pill esophagitis. The risk may be higher in patients with existing esophageal disorders or those who take the medication with insufficient water. Cresemba is an antifungal medication that comes in both capsule and intravenous forms, and proper administration technique is important to reduce the risk of esophageal irritation. According to the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1, a diagnostic trial of antifungal therapy is usually appropriate before endoscopy is used to identify causes of esophagitis. However, the provided evidence does not specifically mention Cresemba as a cause of pill esophagitis, but it does discuss the importance of proper administration technique for antifungal medications to minimize the risk of esophageal irritation. It is essential to follow the recommended administration guidelines to reduce the risk of pill esophagitis when taking Cresemba. In cases where esophageal candidiasis is suspected, treatment with fluconazole or itraconazole solution is recommended 1. However, the primary concern is to minimize the risk of pill esophagitis by proper administration technique, and if symptoms occur, to promptly seek medical attention.
From the Research
Pill Esophagitis and Cresemba (Isavuconazonium Sulfate)
There is no direct evidence in the provided studies that links Cresemba (isavuconazonium sulfate) to esophageal pill-induced injury, also known as pill esophagitis.
Characteristics of Pill Esophagitis
- Pill esophagitis occurs when caustic medicinal pills dissolve in the esophagus rather than passing rapidly into the stomach as intended 2.
- The incidence of this iatrogenic injury can be reduced but not eliminated by emphasizing the importance of taking pills while upright and with plenty of fluids 2.
- Drug-induced injury of the oesophagus is a common cause of oesophageal complaints, with more than 70 drugs reported to induce oesophageal disorders 3.
- Capsules or tablets are commonly delayed in their passage through the oesophagus, and highly caustic coatings, direct medication injury, and poor oesophageal clearance of pills can lead to acute inflammation 3.
Examples of Medications Causing Pill Esophagitis
- Antibacterials such as doxycycline, tetracycline, and clindamycin are common causes of pill-induced oesophagitis 3.
- Other medications, including aspirin, potassium chloride, ferrous sulfate, quinidine, alprenolol, and various steroidal and nonsteroidal anti-inflammatory agents, have also been reported to cause oesophageal injury 3.
- Telithromycin has been reported to cause pill-induced esophagitis in at least one case 4.
- Ascorbic acid has also been reported to cause esophagitis in a rare case 5.
Prevention and Treatment
- Simple advice on how and when to take medication could probably prevent most cases of pill esophagitis 6.
- Avoidance of implicated medications in patients with significant risk factors for developing pill esophagitis could prevent additional cases 6.
- Treatment of pill esophagitis includes immediate discontinuation of the offending agent, supportive care, and medical management with sucralfate and acid-suppressing therapy if necessary 6.