Itraconazole

Aka: Itraconazole, Sporanox, Tolsura

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II. Indications

  1. Onychomycosis

III. Metabolism

  1. Hepatic Cytochrome P450

IV. Preparations

  1. Intraconazole (standard formulation)
  2. Tolsura
    1. Higher Bioavailable formulation (greater GI absorption) released in 2019
    2. Itraconazole 200 mg is equivalent to 130 mg Tolsura
    3. Indications
      1. Blastomycosis
      2. Histoplasmosis
      3. Aspergillosis
    4. Precautions
      1. Increased serum levels with acid suppression (e.g. Proton Pump Inhibitor)
      2. Five fold higher cost than Itraconazole ($70/day instead of $15/day)
    5. References
      1. (2019) Presc Lett 26(2): 9

V. Drug Interactions: Serious (Contraindicated)

  1. Serious Arrhythmia with
    1. Astemizole
    2. Cisapride
    3. Quinidine
    4. Pimozide (Orap)
  2. Rhabdomyolysis Risk
    1. HMG-CoA Reductase Inhibitors (e.g. Simvastatin)
  3. Significant sedation with Benzodiazepines
    1. Midazolam (Versed)
    2. Triazolam (Halcion)
    3. Avoid other Benzodiazepines also
    4. Avoid Barbiturates (e.g. Phenobarbital)

VI. Drug Interactions: Other

  1. Medications raising gastric pH and lowering absorption
    1. H2 Blockers (e.g. Ranitidine)
    2. Proton Pump Inhibitors (e.g. Omeprazole)
  2. Oral Hypoglycemics (e.g. Sulfonylureas)
    1. Risk of Hypoglycemia
  3. Increased bleeding risk with Warfarin

VII. Dosing: Onychomycosis

  1. Fingernails
    1. Daily (continuous): 200 mg daily for 6 weeks
    2. Monthly (pulsed): 200 mg twice daily for one week/month for 2-3 months
  2. Toenails
    1. Daily (continuous): 200 mg daily for 12 weeks
    2. Monthly (pulsed): 200 mg twice daily for one week/month for 3-4 months

VIII. Dosing: Tinea Capitis

  1. Daily
    1. Solution 3 mg/kg/day up to 500 mg/day for 4-6 weeks
    2. Capsules 5 mg/kg/day up to 500 mg/day for 4-6 weeks
  2. Monthly
    1. Solution 3 mg/kg/day up to 500 mg/day, daily for one week per month for 2-3 months
    2. Capsules 5 mg/kg/day up to 500 mg/day, daily for one week per month for 2-3 months

IX. Directions

  1. Take with food (lower pH increases absorption)

X. Monitoring: Onychomycosis

  1. Pulse therapy: no monitoring
  2. Continuous therapy: Labs at baseline (previously also recommended every 6 weeks)
    1. Aspartate Aminotransferase (AST)
    2. Alanine Aminotransferase (ALT)

XI. References

  1. Boogaerts (2001) Drugs 61(Suppl I):39-47 [PubMed]
  2. De Beule (2001) Drugs 61(Suppl I):27-37 [PubMed]
  3. De Doncker (1997) J Am Acad Dermatol 37:969-74 [PubMed]
  4. Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]
  5. Friedlander (1999) Pediatr Infect Dis J 18(2):205-10 [PubMed]
  6. Gupta (1998) Int J Dermatol 37:303-8 [PubMed]
  7. Gupta (1999) J Am Acad Dermatol 41:237-49 [PubMed]
  8. Gupta (2001) Eur J Dermatol 11(1):6-10 [PubMed]

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Related Studies

Cost: Medications

itraconazole (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ITRACONAZOLE 100 MG CAPSULE Generic $0.88 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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