• Ketoconazole is contraindicated
• A two-fold increase in isavuconazole exposure was observed with the strong CYP3A4 inhibitor lopinavir/ritonavir
• A less pronounced effect can be expected with other strong CYP3A4/5 inhibitors such as clarithromycin, indinavir and saquinavir
• No dose adjustment of isavuconazole is necessary when co-administered with strong CYP3A4/5 inhibitors; however, caution is advised as adverse drug reactions may increase

• No dose adjustment is warranted for moderate to mild CYP3A4/5 inhibitors

• Co-administration with mild CYP3A4/5 inducers such as aprepitant, prednisone and pioglitazone may result in mild to moderate decreases in isavuconazole plasma levels
• Co-administration with mild CYP3A4/5 inducers should be avoided unless the potential benefit is considered to outweigh the risk
• Co-administration of isavuconazole with potent CYP3A4/5 inducers such as rifampicin, rifabutin, carbamazepine, long-acting barbiturates (e.g., phenobarbital), phenytoin and St. John's wort, or with moderate CYP3A4/5 inducers such as efavirenz, nafcillin and etravirine, is contraindicated, since these medicinal products can significantly decrease plasma concentrations of isavuconazole.
• Co-administration with high-dose ritonavir (>200 mg twice daily) is contraindicated, as at high doses ritonavir may induce CYP3A4/5 and decrease isavuconazole plasma concentrations.

• Isavuconazole can be considered a moderate inhibitor of CYP3A4/5, and systemic exposure to medicinal products metabolised by CYP3A4 may be increased when co-administered with CRESEMBA
• Concomitant use of CRESEMBA with CYP3A4 substrates such as the immunosuppressants tacrolimus, sirolimus or ciclosporin may increase systemic exposure to these medicinal products
• Appropriate therapeutic drug monitoring and dose adjustment may be necessary during co-administration

• Isavuconazole is an inducer of CYP2B6
• Systemic exposure to medicinal products metabolised by CYP2B6 may be decreased when co-administered with CRESEMBA. Therefore, caution is advised when CYP2B6 substrates, especially medicinal products with a narrow therapeutic index such as cyclophosphamide, are co-administered with CRESEMBA
• The use of the CYP2B6 substrate efavirenz with CRESEMBA is contraindicated because efavirenz is a moderate inducer of CYP3A4/5

• Isavuconazole may increase the exposure of medicinal products that are P-gp substrates 
• Dose adjustment of medicinal products that are P-gp substrates, especially medicinal products with a narrow therapeutic index such as digoxin, colchicine and dabigatran etexilate, may be needed when concomitantly administered with CRESEMBA

• Isavuconazole is an inhibitor in vitro of BCRP, and plasma concentrations of substrates of BCRP may therefore be increased. Caution is advised when isavuconazole is given concomitantly with substrates of BCRP.

• Isavuconazole is a mild inhibitor of the organic cation transporter 2 (OCT2). Co-administration of isavuconazole with medicinal products which are substrates of OCT2 may result in increased plasma concentrations of these medicinal products

• Isavuconazole is a mild inhibitor of UGT. Co-administration of isavuconazole with medicinal products which are substrates of UGT may result in mildly increased plasma concentrations of these medicinal products.

• There are no data from the use of CRESEMBA in pregnant women
• Animal studies have shown reproductive toxicity but the potential risk for humans is unknown
• CRESEMBA must not be used during pregnancy except in patients with severe or potentially life-threatening fungal infections, in whom isavuconazole may be used if the anticipated benefits outweigh the possible risks to the foetus

• CRESEMBA is not recommended for women of childbearing potential who are not using contraception

• Available pharmacodynamic/toxicological data in animals have shown excretion of isavuconazole/metabolites in milk
• Breast-feeding should be discontinued during treatment with CRESEMBA
• A risk to newborns and infants cannot be excluded

• There are no data on the effect of CRESEMBA on human fertility
• Studies in animals did not show impairment of fertility in male or female rats

The frequency of adverse reactions is based on data from 403 patients with invasive fungal infections treated with CRESEMBA in phase 3 studies.

The most common treatment-related adverse events were:

• Elevated liver chemistry tests (7.9%)
• Nausea (7.4%)
• Vomiting (5.5%)
• Dyspnoea (3.2%)
• Abdominal pain (2.7%)
• Diarrhoea (2.7%)
• Injection-site reaction (2.2%)
• Headache (2.0%)
• Hypokalaemia (1.7%)
• Rash (1.7%)

Adverse reactions that most often led to permanent discontinuation of CRESEMBA were:

• Confusional state (0.7%)
• Acute renal failure (0.7%)
• Increased blood bilirubin (0.5%)
• Convulsion (0.5%)
• Dyspnoea (0.5%)
• Epilepsy (0.5%)
• Respiratory failure (0.5%)
• Vomiting (0.5%)

Other adverse reactions include hypersensitivity, syncope, heart rhythm disturbances and circulatory collapse. Please refer to the Cresemba Summary of Product Characteristics for a full list.

• CRESEMBA has a moderate potential to influence the ability to drive and use machines
• Patients should avoid driving or operating machinery if they experience symptoms of confusional state, somnolence, syncope and/or dizziness

• Symptoms reported more frequently at supratherapeutic doses of CRESEMBA (equivalent to isavuconazole 600 mg/day) evaluated in a QT study than in the therapeutic dose group (equivalent to isavuconazole 200 mg/day dose) included: headache, dizziness, paraesthesia, somnolence, disturbance in attention, dysgeusia, dry mouth, diarrhoea, oral hypoaesthesia, vomiting, hot flush, anxiety, restlessness, palpitations, tachycardia, photophobia and arthralgia
• In the event of an overdose, initiate supportive treatment. Isavuconazole is not removed by haemodialysis and there is no specific antidote for isavuconazole

• The clinical safety of isavuconazole was assessed in 77 paediatric patients who received at least one dose of intravenous or oral isavuconazole. This included 46 paediatric patients who received isavuconazole as a single dose and who also received other antifungals for prophylaxis, and 31 patients with suspected or confirmed invasive aspergillosis or mucormycosis who received isavuconazole as primary therapy for up to 181 days. Overall, the safety profile of isavuconazole in the paediatric population was similar to that in adults.