Itraconazole

Indications & Dose:

Blastomycosis, histoplasmosis, aspergillosis, oropharyngeal candidiasis (sol), esophageal candidiasis (sol), superficial mycoses (dermatophytoses. pityriasis versicolor, sebopsoriasis, candidiasis ), onychomycosis, systemic mycoses (candidiasis, cryptococcal infections, paracoccidioidomycosis, coccidioidomycosis. subcutaneous mycoses (sporotrichosis, chromomycosis), cutaneous leishmaniasis, fungal keratitis, alternariosis, zygomycosis

DOSE

Adult

• BY MOUTH

• Oropharyngeal candidiasis PO 200 mg sol (20 ml) qd for 1-2 wk

• Oropharyngeal candidiasis refractory to fluconazole: PO 100 mg sol (10 ml) bid

• Esophageal candidiasis: PO 100 mg sol (10 ml) qd for 3 wk, treat for at least 2 wk past resolution of symptoms

• Blasromycosis/histoplasmosis: PO 200 mg qd; may increase if evidence of progressive disease to 300- 400 mg/day in 2 divided doses

• Aspergillosis: PO 200-400 mg/ day; doses >200 mg/day should be given in 2 divided doses

• Life-threatening situations: PO loading dose of 200 mg tid should be given for 1st 3 days

• Onychomycosis: PO 200 mg qd for at least 3 mo or 200 mg qd x 1 wk/mo

Vulvovaginal candidiasis: 200mg twice daily for 1 day.

Tinea pedis & tinea manuum: 100mg daily for 30 days.

Onchomycosis: Either 200mg daily for 3 months or course (‘pulse’) of 200mg twice daily for 7 days, subsequent courses repeated after 21-day interval; fingernails 2 courses, toenails 2 courses.

Alternative in systemic infections: 200mg once daily (candidiasis 100-200mg once daily) increased in invasive or disseminated disease and in cryptococcal meningitis to 200mg twice daily.

Maintenance in AIDS patients and prophylaxis in neutropenia: 200mg once daily, increased to 200mg twice daily if low plasma itraconazole concentrations.

Non meningeal crypttococcosis; 200mg once daily Cryptococeal menengitis; 200 mg twice daily Prophylaxis in Neutropenia; 200mg once daily increasing to 200mg twice daily if itraconazole blood levels are low

Elderly & Children Not recommended.

Contraindications:

Side Effects:

Cautions:

Precautions:

Hypersensitivity to other azole antifungals; preexisting hepatic function abnormalities, children, hypochlorhydria (reduces drug absorption)

Interaction:

Drugs

Alprazolam: Increased plasma

Aluminum: Reduced itraconazole absorption

Amprenavir: Increased plasma amprenavir concentration

Antacids: Reduced itraconazole absorption

Astemizole: QT prolongation and life-threatening dysrhythmia 

Atevirdine: Increased plasma at evirdine concentration

Atorvastatin: Increased plasma atorvastatin concentration with risk of rhabdomyolysis

Buspirone: Increased plasma buspirone concentration

Calcium: Reduced itraconazole absorption

Cerivastatin: Increased plasma cerivastatin concentration with risk of rhabdomyolysis

Chlordiazepoxide: Increased plasma chlordiazepoxide concentration

Cimetidine: Reduced itraconazole absorption

Cisapride: QT prolongation and life-threatening dysrhythmia

Clarithromycin: Increased plasma itraconazole concentration

Cyclosporine: Increased plasma cyclosporine concentration

Diazepam: Increased plasma diazepam concentration

Digoxin: Increased plasma digoxin concentration

Didanosine: Reduced itraconazole absorption

Erythromycin: Increased plasma itraconazole concentration

Ethanol: Disulfiram-like reaction possible

Famotidine: Reduced itraconazole absorption

Felodipine: Increased plasma felodipine concentration

Fluvastatin: Increased plasma fluvastatin concentration with risk of rhabdomyolysis

Food: Increased itraconazole absorption

Indinavir: Increased plasma indinavir concentration

Lansoprazole: Reduced itraconazole absorption

Lovastatin: Increased plasma lovastatin concentration with risk of rhabdomyolysis

Magnesium: Reduced itraconazole absorption

Methadone: Increased plasma methadone concentration

Methylprednisolone: Increased plasma methyl prednisolone concentration

Midazolam: Increased plasma midazolam concentration

Nelfinavir: Increased plasma nelfinavir concentration

Nizatidine: Reduced itraconazole absorption

Omeprazole: Reduced itraconazole absorption

Oral anticoagulants: Increased hypoprothrombinemic response

Phenytoin: Markedly reduced Plasma itraconazole concentration

Pimozide: Increased plasma pimozide concentration, QT prolongation and life-threatening dysrhythmia

Pravastatin: Increased plasma pravastatin concentration with risk of rhabdomyolysis

Quinidine: Increased plasma quinidine concentration, QT prolongation and life-threatening dysrhythmia 

Rifampin: Decreased plasma itraconazole concentration; decreased plasma rifampin concentration

Ritonavir: Increased plasma ritonavir concentration

Saquinavir: Increased plasma saquinavir concentration

Simvastatin: Increased plasma simvastatin concentration with risk of rhabdomyolysis

Sodium bicarbonate: Reduced itraconazole absorption

Sucralfate: Reduced itraconazole absorption

Tacrolimus: Increased plasma taerolimus concentration

Terfenadine: QT prolongation and life-threatening dysrhythmia

Tolbutamide: Increased plasma tolbutamide concentration

Triazolam: Increased plasma triazolam concentration

Warfarin: Increased hypoprothrombinemic response 

Warnings:

Adverse Effects:

Lactations:

Excreted into breast milk; do not administer to nursing mothers 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Decreased libido, depression, dizziness, fatigue, fever, headache, insomnia, malaise, somnolence

CV: Edema, hypertension

GI: Abdominal pain, anorexia, diarrhea, hepatitis, liver function test * abnormality, nausea, vomiting

GU: Albuminuria, impotence

METAB: Hypokalemia

SKIN: Pruritus, rash (more common a in patients receiving immunosuppressants)

Patient And Carer Advice: