Itraconazole, though considered to be one of the best fungicidal drugs available, the adverse effect list is quite long. Itraconazone size effects are not only confined to individual drug reaction. It has many complex drug interactions, due to which one must be cautious before prescribing itraconazole. Itraconazole is often advised for tinea ( Tinea cruris, Tinea pedis, Tinea unguium, Tinea capitis, tinea manuuam ) pityriasis versicolor, dermatophtes, blastomycosis, aspergillosis, histoplasmosis, onycomycoses, otomycosis, oral candidiasis, vaginal candidiasis, etc.
How does itracoanzole work?
Itraconazole is a triazole and binds to the fungal p450 enzymes and stops the cells making ergosterol, the main component of the cell wall.
How is itaconazole Taken?
Most preferred route is oral. Preparations are available as 100/200/400 mg tablets or 10 mg/ml liquid preparations. Following are some regimes indicated for various dermatological/systemic conditions:
- Tinea corporis, tinea cruris: 200 mg daily for one week OR 100mg daily for 2 weeks
- Tinea pedis, tinea manuum: 200 mg twice daily for one week OR 100mg daily for 2-4 weeks
- Vulvovaginal candidiasis: 200 mg twice daily for one day OR 200 mg daily for 3 days
- Oral candidiasis: 100 mg daily for two weeks
- Tinea unguium: 200 mg/day for 6-8 weeks (fingernails) or 3-4 months (toenails), OR 200 mg twice daily for 7 days, repeated monthly for 2 months (fingernails) or 3–4 months (toenails)
- Pityriasis versicolor: 200 mg/day for 10 days, with a preventative dose of 200mg once monthly for 6 months.
- Blastomycosis: 800 mg in divided doses initially for 3-4 days, then 200-400 mg/day for at least 3 months
- All fluconazole refractory cases
What are the most common Itraconazole Side Effects?
Frequently encountered size effects are:
Rash, Headache, Vomiting, Edema, Abnormal liver function test results, Fatigue, Abdominal pain, Dizziness, Hypertriglyceridemia, Diarrhea, Fever, Hypertension, Pruritus, Hypokalemia, Albuminuria, Anorexia, Decreased libido, Hepatitis, Malaise.
Most Severe Itraconazole Side effects:
Blood and Lymphatic System Disorders: Leukopenia, neutropenia, thrombocytopenia, Immune System Disorders: Anaphylaxis; anaphylactic, anaphylactoid and allergic reactions; serum sickness; angioneurotic edema, Nervous System Disorders: Peripheral neuropathy, paresthesia, hypoesthesia, tremor, Eye Disorders: Visual disturbances, including vision blurred and diplopia, Ear and Labyrinth Disorders: Transient or permanent hearing loss, Cardiac Disorders: Congestive heart failure, Respiratory, Thoracic and Mediastinal Disorders: Pulmonary edema, dyspnea, Gastrointestinal Disorders: Pancreatitis, dysgeusia, Hepatobiliary Disorders: Serious hepatotoxicity (including some cases of fatal acute liver failure), hepatitis, Skin and Subcutaneous Tissue Disorders: Toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, erythema multiforme, exfoliative dermatitis, leukocytoclastic vasculitis, alopecia, photosensitivity, urticaria, Musculoskeletal and Connective Tissue Disorders: Arthralgia, Renal and Urinary Disorders: Urinary incontinence, pollakiuria, Reproductive System and Breast Disorders: Erectile dysfunction, General Disorders and Administration Site: Peripheral edema.
Itraconazole may precipitate congestive heart failure. Best avoided for conduction disorders, arrhythmia and h/o previous MI.
Itraconazole has important interactions with other medications.
- methadone, disopyramide, dofetilide, dronedarone, quinidine, ergot alkaloids, irinotecan, lurasidone, oral midazolam, pimozide, triazolam, felodipine, nisoldipine, ranolazine, eplerenone, cisapride, lovastatin, simvastatin, ticagrelor, and, in patients with varying degrees of renal or hepatic impairment, colchicine, fesoterodine, telithromycin, and solifenacin
- Coadministration with itraconazole can cause elevated plasma concentrations of these drugs and may increase or prolong both the pharmacologic effects and/or adverse reactions to these drugs (eg, increased plasma concentrations of some of these drugs can lead to QT prolongation and ventricular tachyarrhythmias including occurrences of torsades de pointes)