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Itraconazole
Aka: Itraconazole, Sporanox, Tolsura
- Indications
- Onychomycosis
- Metabolism
- Hepatic Cytochrome P450
- Preparations
- Intraconazole (standard formulation)
- Tolsura
- Higher bioavailable formulation (greater GI absorption) released in 2019
- Itraconazole 200 mg is equivalent to 130 mg Tolsura
- Indications
- Blastomycosis
- Histoplasmosis
- Aspergillosis
- Precautions
- Increased serum levels with acid suppression (e.g. Proton Pump Inhibitor)
- Five fold higher cost than Itraconazole ($70/day instead of $15/day)
- References
- (2019) Presc Lett 26(2): 9
-
Drug Interactions: Serious (Contraindicated)
- Serious Arrhythmia with
- Astemizole
- Cisapride
- Quinidine
- Pimozide (Orap)
- Rhabdomyolysis Risk
- HMG-CoA Reductase Inhibitors (e.g. Simvastatin)
- Significant sedation with Benzodiazepines
- Midazolam (Versed)
- Triazolam (Halcion)
- Avoid other Benzodiazepines also
- Avoid Barbiturates (e.g. Phenobarbital)
-
Drug Interactions: Other
- Medications raising gastric pH and lowering absorption
- H2 Blockers (e.g. Ranitidine)
- Proton Pump Inhibitors (e.g. Omeprazole)
- Oral Hypoglycemics (e.g. Sulfonylureas)
- Risk of Hypoglycemia
- Increased bleeding risk with Warfarin
- Dosing: Onychomycosis
- Fingernails
- Daily (continuous): 200 mg daily for 6 weeks
- Monthly (pulsed): 200 mg twice daily for one week/month for 2-3 months
- Toenails
- Daily (continuous): 200 mg daily for 12 weeks
- Monthly (pulsed): 200 mg twice daily for one week/month for 3-4 months
- Dosing: Tinea Capitis
- Daily
- Solution 3 mg/kg/day up to 500 mg/day for 4-6 weeks
- Capsules 5 mg/kg/day up to 500 mg/day for 4-6 weeks
- Monthly
- Solution 3 mg/kg/day up to 500 mg/day, daily for one week per month for 2-3 months
- Capsules 5 mg/kg/day up to 500 mg/day, daily for one week per month for 2-3 months
- Directions
- Take with food (lower pH increases absorption)
- Monitoring: Onychomycosis
- Pulse therapy: no monitoring
- Continuous therapy: Labs at baseline (previously also recommended every 6 weeks)
- Aspartate Aminotransferase (AST)
- Alanine Aminotransferase (ALT)
- References
- Boogaerts (2001) Drugs 61(Suppl I):39-47 [PubMed]
- De Beule (2001) Drugs 61(Suppl I):27-37 [PubMed]
- De Doncker (1997) J Am Acad Dermatol 37:969-74 [PubMed]
- Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]
- Friedlander (1999) Pediatr Infect Dis J 18(2):205-10 [PubMed]
- Gupta (1998) Int J Dermatol 37:303-8 [PubMed]
- Gupta (1999) J Am Acad Dermatol 41:237-49 [PubMed]
- Gupta (2001) Eur J Dermatol 11(1):6-10 [PubMed]