Itraconazole (Sporanox) - Uses, Dose, Side effects, MOA, Brands

Itraconazole, available as capsules, tablets, and oral solution by the brand name of Sporanox, is a triazole antifungal drug. It is used in the treatment of infections of the lungs, gastrointestinal tract, and skin caused by susceptible fungal organisms.

Itraconazole (Sporanox) Uses:

Aspergillosis (capsules):
- Itraconazole is used to treat aspergillosis (whether pulmonary or extrapulmonary) if a patient is resistant or intolerant to Amphotericin B therapy.
- According to the Infectious disease society of America amphotericin B formulations for invasive aspergillosis is recommended only when voriconazole is contraindicated or not tolerated.
Blastomycosis (capsules):
- Itraconazole is also used to treat blastomycosis (both pulmonary and extrapulmonary) in patients who are immunocompromised as well as those who are immunocompetent.
Histoplasmosis (capsules):
- Itraconazole is used in the treatment of histoplasmosis for chronic cavitary pulmonary and disseminated diseases except in meningeal histoplasmosis in both immunocompromised and immunocompetent patients.
Onychomycosis:
- Capsules (100 mg [Sporanox]):
  - Itraconazole capsule is also used to treat onychomycosis of the toenail, and onychomycosis of the fingernail caused by dermatophytes (tinea unguium).
- Tablets:
  - It is used to treat onychomycosis of the toenail caused by Trichophyton rubrum or Trichophyton mentagrophytes.
Oropharyngeal/Esophageal candidiasis (oral solution):
- It is used to treat oropharyngeal and esophageal candidiasis.
Candidiasis, oral, and/or esophageal:
- It is used to treat oral and/or esophageal candidiasis in immunocompromised and immunocompetent patients.
Chromomycosis:
- Itraconazole is also used in the treatment of chromomycosis in immunocompromised as well as immunocompetent patients
Dermatomycoses:
- It is used to treat dermatomycoses due to tinea pedis, tinea cruris, tinea corporis, and of pityriasis versicolor in patients for whom oral therapy is appropriate
Onychomycosis:
- Itraconazole is used to treat onychomycosis in immunocompromised and immunocompetent patients
Paracoccidioidomycosis:
- Itraconazole is also used in the treatment of paracoccidioidomycosis in immunocompromised and immunocompetent patients
Sporotrichosis:
- It is used to treat cutaneous and lymphatic sporotrichosis in immunocompromised and immunocompetent patients
Off Label Use of Itraconazole in Adults:
- Candidiasis, vulvovaginal in HIV-infected patients
- Coccidioidal meningitis in HIV-infected patients
- Coccidioidal pneumonia in HIV-infected patients; Coccidioidomycosis (non-HIV infected)
- Cryptococcosis in HIV-infected patients
- Microsporidiosis, disseminated in HIV-infected patients
- Penicilliosis in HIV-infected patients

Itraconazole (Sporanox) Dose in Adults:

Note:

Formulations are not interchangeable.
Generally, the oral solution is the preferred formulation because of improved absorption.

Itraconazole (Sporanox) Dose as an alternative agent in the treatment of Invasive Aspergillosis, (salvage therapy):

Oral solution:
- 200 mg twice daily;
- duration of therapy is a minimum of 6 to 12 weeks, although the duration is highly dependent on the degree/duration of immunosuppression, disease site, and evidence of disease improvement.
Oral capsule (65 mg [Tolsura]):
- 130 mg once or twice daily;
- for life-threatening infections, administer a loading dose of 130 mg 3 times daily for the first 3 days of therapy;
- treatment should be continued for ≥3 months and until clinical and laboratory resolution.

Itraconazole (Sporanox) Dose in the treatment of Blastomycosis:

Oral solution or capsule (100 mg [Sporanox]):
- 200 mg 3 times daily for 3 days, then 200 mg twice daily for 6 to 12 months;
- in moderately severe to severe infection, therapy should be initiated with ~2 weeks of amphotericin B.
Oral capsule (65 mg [Tolsura]):
- 130 mg once daily;
- if no improvement or if there is evidence of progressive fungal infection, increase dose in 65 mg increments to a maximum of 260 mg/day (doses >130 mg/day should be given in 2 divided doses).
- For life-threatening infections, a loading dose of 130 mg 3 times daily for the first 3 days of therapy should be administered;
- The treatment should be continued for ≥3 months and until clinical and laboratory resolution.

Itraconazole (Sporanox) Dose in the treatment of Candidiasis: Oral:

Esophageal:
- Oral solution:
  - Fluconazole-refractory disease:
    - 200 mg once daily for 14 to 21 days.
  - HIV-infected patients:
    - 200 mg once daily for 14 to 21 days.
- US labeling:
  - Dosing in the prescribing information may not reflect current clinical practice.
  - Oral solution: 100 to 200 mg once daily
- Canadian labeling:
  - Oral solution:
    - 100 to 200 mg once daily for a minimum of 3 weeks; continue dosing for 2 weeks after resolution of symptoms
  - Oral capsule (100 mg [Sporanox]):
    - 100 mg once daily for 4 weeks
Oropharyngeal:
- Oral solution:
  - Fluconazole-refractory disease:
    - 200 mg once daily for up to 28 days.
  - HIV-infected patients (alternative agent):
    - Oral solution: 200 mg once daily for 7 to 14 days.
- US labeling:
  - Dosing in the prescribing information may not reflect current clinical practice.
  - Oral solution: 200 mg once daily;
  - in patients unresponsive or refractory to fluconazole: 100 mg twice daily
- Canadian labeling:
  - Oral solution: 200 mg once daily or in divided doses daily for 1 to 2 weeks
  - Oral capsule (100 mg [Sporanox]): 100 mg once daily for 2 weeks

Itraconazole (Sporanox) Dose in the treatment of Vulvovaginal (uncomplicated) in HIV-infected patients (alternative to preferred therapy) (off label):

Oral solution: 200 mg once daily for 3 to 7 days.

Itraconazole (Sporanox) Dose in the treatment of Chromomycosis: Canadian labeling (not in US labeling):

Oral capsule (100 mg [Sporanox]): 200 mg once daily for 6 months

Itraconazole (Sporanox) Dose in the treatment of Coccidioidomycosis, extrapulmonary (non-HIV infected) (off-label): Oral:

Soft tissue infection (not associated with bone infection):
- 200 mg twice daily for at least 6 to 12 months.
Bone and/or joint infection:
- 200 mg twice daily for 3 years to lifetime, depending on the severity and host immunocompetence.
- Note: Amphotericin B may be used initially in severe cases and then switched to itraconazole.

Itraconazole (Sporanox) Dose in the treatment of Coccidioidal pneumonia (off-label): Oral:

Non-HIV infected (symptomatic, chronic cavitary):
- Oral: 200 mg twice daily for at least 12 months.
HIV-infected patients (focal pneumonia):
- 200 mg twice daily.

Itraconazole (Sporanox) Dose in the treatment of Coccidioidal meningitis (off-label):

Non-HIV infected:
- Oral: 200 mg 2 to 4 times daily; close monitoring required to assure adequate absorption.
HIV-infected patients (HHS [OI adult 2017]) (alternative agent): Oral:
- Treatment: 200 mg 3 times daily for 3 days, then 200 mg twice daily, followed by chronic suppressive therapy
Chronic suppressive therapy:
- 200 mg twice daily continued indefinitely, even with an increase in CD4 count on ART

Itraconazole (Sporanox) Dose as an alternative agent in the treatment of Cryptococcosis in HIV-infected patients (off-label use): Oral:

Treatment, consolidation therapy:
- 200 mg twice daily for ≥8 weeks.
Histoplasmosis:
- Treatment:
  - Oral solution or capsule (100 mg [Sporanox]):
    - 200 mg 3 times daily for 3 days, then 200 mg twice daily (or once daily in mild-moderate disease) for 6 to 12 weeks in mild to moderate disease or ≥12 months in progressive disseminated or chronic cavitary pulmonary histoplasmosis;
    - in moderately severe to severe infection, therapy should be initiated with ~2 weeks of a lipid formation of amphotericin B.
  - Oral capsule (65 mg [Tolsura]):
    - 130 mg once daily;
    - if no improvement or if there is evidence of progressive fungal infection, increase dose in 65 mg increments to a maximum of 260 mg/day (doses >130 mg/day should be given in 2 divided doses).
    - For life threatening infections, administer a loading dose of 130 mg 3 times daily for the first 3 days of therapy;
    - treatment should be continued for ≥3 months and until clinical and laboratory resolution.
- HIV-infected patients (oral solution or capsule [100 mg (Sporanox)]):
  - Mild disseminated disease:
    - Induction and maintenance therapy:
      - 200 mg 3 times daily for 3 days, then 200 mg twice daily for ≥12 months (HHS [OI adult 2017])
  - Moderate to severe disseminated disease:
    - Maintenance therapy (following at least 2 weeks of induction therapy with an appropriate agent):
      - 200 mg 3 times daily for 3 days, then 200 mg twice daily for ≥12 months (HHS [OI adult 2017])

Itraconazole (Sporanox) Dose in the treatment of Meningitis:

Maintenance therapy (following 4 to 6 weeks of induction therapy with an appropriate agent):
- 200 mg 2 to 3 times daily for ≥12 months and until resolution of abnormal CSF findings.
Prophylaxis (off-label):
- Oral solution or capsule (100 mg [Sporanox]):
  - Primary prophylaxis in HIV-infected patients:
    - 200 mg once daily;
    - primary prophylaxis is indicated when CD4 count <150 cells/mm and at increased risk of exposure.
  - Long-term suppression therapy (secondary prophylaxis) in HIV-infected patients:
    - 200 mg once daily; long-term suppressive therapy is indicated in patients who relapse despite appropriate therapy or in patients with CNS or severe disseminated infection.

Itraconazole (Sporanox) Dose in the treatment of Microsporidiosis, disseminated (caused by Trachipleistophora or Anncaliia) in HIV infected patients (off-label):

Oral: 400 mg once daily in combination with albendazole.

Itraconazole (Sporanox) Dose in the treatment of Onychomycosis (fingernail involvement only):

Oral capsule (100 mg [Sporanox]):
- 200 mg twice daily for 1 week; repeat 1-week course after 3-week off-time

Itraconazole (Sporanox Dose in the treatment of Onychomycosis (toenails due to Trichophyton rubrum or T. mentagrophytes):

Oral tablet: 200 mg once daily for 12 consecutive weeks.

Itraconazole (Sporanox Dose in the treatment of Onychomycosis (toenails with or without fingernail involvement):

Oral capsule (100 mg [Sporanox]):
- 200 mg once daily for 12 consecutive weeks
Canadian labeling (not in US labeling):
- Oral capsule (100 mg [Sporanox]):
  - "Pulse-dosing": 200 mg twice daily for 1 week;
  - repeat 1-week course twice with 3-week off-time between each course

Itraconazole (Sporanox) Dose in the treatment of Paracoccidioidomycosis:

Canadian labeling (not in US labeling):
- Oral capsule (100 mg [Sporanox]): 100 mg once daily for 6 months

Itraconazole (Sporanox) Dose in the treatment of Penicilliosis in HIV-infected patients:

Primary prophylaxis:
- 200 mg once daily for patients with a CD4 count <100 cells/mm³ who spend extensive time in northern Thailand, Vietnam, and Southern China, especially rural areas
Treatment:
- 200 mg twice daily for 8 weeks (mild disease) or 10 weeks (severe infections), then continue with maintenance therapy. In severely ill patients, initiate therapy with 2 weeks of liposomal amphotericin B.
Chronic maintenance (secondary prophylaxis):
- 200 mg once daily until CD4 count >100 cells/mm³ for ≥6 months in response to ART

Itraconazole (Sporanox) Dose in the treatment of Pityriasis versicolor:

Canadian labeling (not in US labeling):
- Oral capsule (100 mg [Sporanox]):
  - 100 mg twice daily or 200 mg once daily for 5 to 7 days

Itraconazole (Sporanox) Dose in the treatment of Sporotrichosis: Oral:

Cutaneous:
- Canadian labeling (not in US labeling): Oral capsule (100 mg [Sporanox]):
  - 100 to 200 mg once daily for 3 to 6 months (localized lesions);
  - 200 mg twice daily for 3 to 6 months (extensive lesions)
Lymphocutaneous:
- 200 mg daily for 3 to 6 months.
- Canadian labeling (not in US labeling): Oral capsule (100 mg [Sporanox]):
  - 100 to 200 mg once daily for 3 to 6 months (localized lesions);
  - 200 mg twice daily for 3 to 6 months (extensive lesions)
Osteoarticular and pulmonary:
- 200 mg twice daily for ≥1 years (may use amphotericin B initially for stabilization).

Itraconazole (Sporanox) Dose in the treatment of Tinea corporis or tinea cruris:

Canadian labeling (not in US labeling):
- Oral capsule (100 mg [Sporanox]):
  - 100 mg once daily for 14 consecutive days or 200 mg once daily for 7 consecutive days.
  - Note: Equivalency between regimens not established.

Itraconazole (Sporanox) Dose in the treatment of Tinea pedis:

Canadian labeling (not in US labeling):
- Oral capsule (100 mg [Sporanox]):
  - 100 mg once daily for 28 consecutive days or 200 mg twice daily for 7 consecutive days.
  - Note: Equivalency between regimens not established.
  - Patients with chronic resistant infection may benefit from lower doses and extended treatment time (100 mg once daily for 28 days).

Itraconazole (Sporanox) Dose in Children:

Note:

Formulations are not interchangeable.
Generally, the oral solution is the preferred formulation because of improved absorption.
Oral absorption varies between patients and as a result, monitoring of serum concentrations is suggested to ensure adequate and nontoxic levels are achieved.
Onmel (tablets) has been discontinued in the US for >1 year.

Itraconazole (Sporanox) General dosing, susceptible infection: Limited data available:

Infants, Children, and Adolescents:
- Oral: 5 mg/kg/dose every 12 hours for treatment;
- The usual maximum daily dose: 200 mg/day;
- some infections may require up to 400 mg/day.

Itraconazole (Sporanox) Dose in the treatment of Blastomycosis, non-CNS infections:

Infants, Children, and Adolescents:
- Oral solution: 5 mg/kg/dose twice daily;
- The maximum dose: 200 mg/dose;
- duration determined by severity and response;
- The usual duration for mild to moderate disease is 6 to 12 months;
- for moderately severe to severe disease a total duration of 12 months including 1 to 2 weeks of amphotericin B.

Itraconazole (Sporanox) Dose in the treatment of Candidiasis (HIV-exposed/-positive patients):

Oropharyngeal, treatment:
- Infants and Children: Fluconazole-refractory: Oral solution:
  - 2.5 mg/kg/dose twice daily for 7 to 14 days;
  - maximum daily dose range: 200 to 400 mg/day
- Adolescents: Oral solution:
  - 200 mg once daily for 7 to 14 days
Esophageal, treatment:
- Infants and Children:
  - Fluconazole-refractory: Oral solution:
    - 2.5 mg/kg/dose twice daily for at least 21 days and at least 2 weeks following resolution of symptoms.
- Adolescents: Oral solution:
  - 200 mg once daily for 14 to 21 days
Vulvovaginal, uncomplicated:
- Adolescents: Oral solution:
  - 200 mg once daily for 3 to 7 days
Secondary prophylaxis:
- Infants and Children: Oral solution:
  - 2.5 mg/kg/dose twice daily

Itraconazole (Sporanox) Dose in the treatment of Coccidioidomycosis:

Treatment:
- Bone and/or joint infection:
  - Infants and Children: Independent of HIV status: Oral solution:
    - 5 mg/kg/dose twice daily for ≥12 months.
  - Adolescents: HIV-exposed/-positive: Oral:
    - 200 mg twice daily.
- Meningitis:
  - HIV-exposed/-positive (HHS [OI adult 2018]): Adolescents:
    - Initial: Oral: 200 mg 3 times daily for 3 days
    - Maintenance: 200 mg twice daily
- Pneumonia, focal (mild disease): HIV-exposed/-positive:
  - Infants and Children: Oral:
    - Initial: 2 to 5 mg/kg/dose 3 times daily for 3 days;
    - maximum dose: 200 mg/dose
    - Maintenance: 2 to 5 mg/kg/dose twice daily;
    - maximum dose: 200 mg/dose; duration of treatment determined by the rate of clinical response.
  - Adolescents:
    - Oral: 200 mg twice daily.
  - Secondary prophylaxis/Chronic suppressive therapy: HIV-exposed/-positive:
    - Infants and Children: Oral:
      - 2 to 5 mg/kg/dose twice daily;
      - maximum dose: 200 mg/dose.
    - Adolescents: Oral:
      - 200 mg twice daily.

Itraconazole (Sporanox) Dose in the treatment of Cryptococcal meningitis (HIV-exposed/-positive):

Consolidation treatment:
- Infants and Children: Oral solution (preferred):
  - Initial load: 2.5 to 5 mg/kg/dose 3 times daily for 3 days;
  - maximum dose: 200 mg/dose
  - Maintenance dose:
    - 5 to 10 mg/kg/day divided once or twice daily for a minimum of 8 weeks;
    - maximum daily dose: 400 mg/day
- Adolescents: Oral:
  - 200 mg twice daily for a minimum of 8 weeks
Secondary prophylaxis/Relapse prevention:
- Infants and Children: Oral solution:
  - 5 mg/kg/dose once daily;
  - maximum daily dose: 200 mg/day

Itraconazole (Sporanox) Dose in the treatment of Histoplasmosis: Limited data available:

Treatment:
- Pulmonary, acute primary disease:
  - HIV-exposed/-positive:
    - Infants and Children: Oral solution (preferred):
      - Initial load: 2 to 5 mg/kg/dose 3 times daily for 3 days;
      - maximum dose: 200 mg/dose
      - Maintenance dose:
      - 2 to 5 mg/kg/dose twice daily for 12 months;
      - maximum dose: 200 mg/dose.
      - Treatment duration of 12 weeks may be adequate in children with functional cellular immunity (CD4 percentage >20% or if age ≥6 years, CD4 cell count >300 cells/mm³) if clinically improved and urine antigen concentrations decreased.
  - Non-HIV-exposed/-positive:
    - Infants, Children, and Adolescents:
      - Oral solution (preferred):
        
        2.5 to 5 mg/kg/dose twice daily for 6 to 12 weeks;
        
        maximum dose: 200 mg/dose.
- Disseminated disease, mild to moderate:
  - HIV-exposed/-positive:
    - Infants and Children: Oral solution (preferred):
      - Initial load:
        
        2 to 5 mg/kg/dose 3 times daily for 3 days;
        
        maximum dose: 200 mg/dose
      - Maintenance dose:
        
        2 to 5 mg/kg/dose twice daily for 12 months;
        
        maximum dose: 200 mg/dose
    - Adolescents: Oral solution (preferred):
      - Initial load: 200 mg 3 times daily for 3 days
      - Maintenance dose: 200 mg twice daily for at least 12 months
  - Non-HIV-exposed/-positive:
    - Infants, Children, and Adolescents:
      - Oral solution (preferred): 2.5 to 5 mg/kg/dose twice daily for 3 to 12 months.
- Disseminated disease, moderately severe to severe:
  - Consolidation treatment following appropriate induction treatment:
  - HIV-exposed/positive:
    - Infants and Children: Oral solution:
      - Initial load: 2 to 5 mg/kg/dose 3 times daily for 3 days; maximum dose: 200 mg/dose
      - Maintenance dose: 2 to 5 mg/kg/dose twice daily for 12 months; maximum dose: 200 mg/dose
    - Adolescents: Oral solution (preferred):
      - Initial load: 200 mg 3 times daily for 3 days
      - Maintenance dose: 200 mg twice daily for ≥12 months
  - Non-HIV-exposed/positive, step-down:
    - Infants, Children, and Adolescents:
      - Oral solution (preferred): 2.5 to 5 mg/kg/dose twice daily for 3 to 12 months based on the severity of disease;
      - maximum dose: 200 mg/dose.
Prophylaxis:
- Primary:
  - HIV-exposed/-positive:
    - Adolescents:
      - Oral: 200 mg once daily.
- Secondary prophylaxis/chronic suppressive therapy:
  - HIV-exposed/-positive:
    - Infants and Children:
      - Oral solution: 5 to 10 mg/kg/dose once daily; maximum dose: 200 mg/dose.
    - Adolescents:
      - Oral: 200 mg once daily.
  - Non-HIV-exposed/positive:
    - Infants, Children, and Adolescents:
      - Oral: 5 mg/kg/dose once daily;
      - maximum dose: 200 mg/dose.

Itraconazole (Sporanox) Dose in the treatment of Microsporidiosis, a disseminated disease caused by Trachipleistophora or Anncaliia, treatment (HIV-exposed/-positive):

Adolescents:
- Oral: 400 mg once daily in conjunction with albendazole.

Itraconazole (Sporanox) Dose in the treatment of Penicilliosis (HIV-exposed/-positive):

Adolescents:
- Primary prophylaxis:
  - Oral: 200 mg once daily for patients with a CD4 count <100 cells/mm³ who spend extensive time in northern Thailand, Vietnam, and Southern China, especially rural areas
- Acute infection (severely ill), treatment:
  - Oral: 200 mg twice daily for 10 weeks;
  - initiate after completion of 2 weeks induction therapy with amphotericin B
- Mild disease, treatment:
  - Oral: 200 mg twice daily for 8 weeks
- Secondary prophylaxis/chronic maintenance therapy:
  - Oral: 200 mg once daily

Itraconazole (Sporanox) Dose in the treatment of Sporotrichosis:

Infants, Children, and Adolescents:
- Lymphocutaneous or localized cutaneous: Oral solution (preferred):
  - 3 to 5 mg/kg/dose twice daily; continue 2 to 4 weeks after all lesions have resolved,
  - usual total duration: 3 to 6 months;
  - maximum dose: 200 mg/dose
- Step down therapy, visceral or disseminated (after initial treatment and clinical response with amphotericin B): Oral:
  - 3 to 5 mg/kg/dose twice daily;
  - continue for at least 12 months;
  - maximum dose: 200 mg/dose

Itraconazole (Sporanox) Dose in the treatment of Tinea capitis, Microsporum canis and trichophyton sp: Limited data available:

Infants, Children, and Adolescents:
- Oral: 5 mg/kg/dose once daily;
- maximum dose: 100 mg/dose;
- duration of therapy depends on the organism:
  - Microsporum sp: 4 to 8 weeks;
  - trichophyton sp:
    - 2 to 3 weeks;
    - up to 12 weeks of treatment may be required.
    - Alternatively, a pulse regimen may be used: 1 week treatment pulses with at least 2 weeks off between pulses
  - Dosing: Renal Impairment:
    - Pediatric Nondialyzable.
    - The manufacturer's labeling states to use with caution in patients with renal impairment;
    - dosage adjustment may be needed.
    - Limited data suggest that no dosage adjustments are required in renal impairment; in adults, wide variations observed in plasma concentrations versus time profiles in patients with uremia or receiving hemodialysis or continuous ambulatory peritoneal dialysis.

Itraconazole Pregnancy Risk Category: C

Postmarketing surveillance has revealed multiple congenital anomalies (eg, skeletal and genitourinary tract malformations, cardiovascular malformations, chromosomal malformations and multiple malformations). However, no causal relationship has been established.
Itraconazole should not be used during pregnancy to treat onychomycosis
Itraconazole should not be used during the first trimester, despite its widespread approval to treat various systemic fungal infections.
It is not recommended for females who are planning to have a baby. Effective contraception should also be used during treatment and for at least 2 months afterward, according to the manufacturer.
The second or third day after menses, therapy should be initiated.

Itraconazole use during breastfeeding:

Breast milk contains Itraconazole.
According to the manufacturer the decision to continue breastfeeding while on therapy should be made based on the risks to infants and the benefits to the mother.
To reduce the risk of HIV transmission, HIV-infected women should stop breastfeeding.

Itraconazole (Sporanox) Dose in Kidney Disease:

A wide variation is observed in those receiving hemodialysis or continuous ambulatory peritoneal dialysis.

Limited data suggest that no dosage adjustments are required in renal impairment.

The manufacturer's labeling states to use with caution in patients with renal impairment; dosage adjustment may be needed.

Hemodialysis: Nondialyzable

Itraconazole (Sporanox) Dose in Liver disease:

Manufacturer's labeling provided no dosage adjustment, however, should be used with caution and monitor closely for signs/symptoms of toxicity.

Common Side Effects of Itraconazole (Sporanox):

Gastrointestinal:
- Diarrhea
- Nausea

Less Common Side Effects of Itraconazole (Sporanox):

Cardiovascular:
- Edema
- Chest Pain
- Hypertension,
Central Nervous System:
- Headache
- Dizziness
- Anxiety
- Depression
- Fatigue
- Pain
- Malaise
- Abnormal Dreams
Dermatologic:
- Skin Rash
- Pruritus
- Diaphoresis
Endocrine & Metabolic:
- Hypertriglyceridemia
- Hypokalemia
Gastrointestinal:
- Vomiting
- Abdominal Pain
- Dyspepsia
- Flatulence
- Gastrointestinal Disease
- Gingivitis
- Aphthous Stomatitis
- Constipation
- Gastritis
- Gastroenteritis
- Increased Appetite
Genitourinary:
- Cystitis
- Urinary Tract Infection
Hepatic:
- Abnormal Hepatic Function Tests
- Increased Liver Enzymes
Infection:
- Herpes Zoster
Neuromuscular & Skeletal:
- Bursitis
- Myalgia
- Tremor
Respiratory:
- Rhinitis
- Upper Respiratory Tract Infection
- Sinusitis
- Cough
- Dyspnea
- Pneumonia
- Pharyngitis
Miscellaneous:
- Fever

Contraindication to Itraconazole (Sporanox):

Hypersensitivity to itraconazole and any component of the formulation
Concurrent administration
- avanafil,
- cisapride,
- disopyramide,
- dofetilide,
- dronedarone,
- eplerenone,
- ergot derivatives,
- Fetodipine
- irinotecan,
- isavuconazole,
- ivabradine,
- Lomotapide
- lovastatin,
- lurasidone,
- Methadone
- midazolam (oral),
- naloxegol,
- nisoldipine,
- pimozide,
- quinidine,
- ranolazine,
- simvastatin,
- ticagrelor, or
- triazolam;
concurrent administration with colchicine, fesoterodine, or solifenacin in patients with varying degrees of renal or hepatic impairment;
Patients who are intermediate or poor metabolizers or patients taking strong or moderate CYP2D6 inhibitors may co-administer eliglustat with them.
Treatment of onychomycosis or other non-life-threatening indications in patients with evidences of ventricular dysfunction (e.g. congestive heart disease (CHF)) or a history CHF.
Treatment of onychomycosis for pregnant women or those who are contemplating becoming pregnant

Canadian labeling: Additional contraindications not in US labeling

Concurrent administration with
- domperidone,
- Eletriptan, and
- fesoterodine in patients with moderate to severe renal or hepatic impairment, or solifenacin in patients with severe renal impairment or moderate to severe hepatic impairment (capsule, oral solution);
- Concurrent administration of the following drugs (none are available in Canada).
  - Astemizole,
  - bepridil,
  - Halofantrine
  - Invabradine
  - lercanidipine,
  - levacetylmethadol
  - mizolastine,
  - Telithromycin is used in patients with severe renal impairment or hepatic impairment.
  - sertindole
  - Terfenadine (capsules, orally solution);
  - Treatment of dermatomycosis in pregnant women (capsule), including tinea cruris (tinea pedis), tinea corporis (tinea corporis), pityriasis vericolor).

Warnings and precautions

CNS depression:
- CNS depression can result. Patients who are required to drive, operate heavy machinery, or perform other activities that require mental alertness must be aware of this.
Hearing loss:
- As reported, it can result in permanent or transient hearing loss.
- Quinidine, a contraindicated medication, was used in multiple of these cases concurrently.
- Most patients experience hearing loss within a few days of stopping therapy. However, some patients may have persistent hearing problems.
Heart failure: [US Boxed Warning]:
- Itraconazole may cause or exacerbate heart failure (HF) in patients already suffering from it.
- Inotropic effects can be caused by intravenous administration.
- It is best to avoid heart disease in patients at high risk (edematous disorders or COPD), and those with a history of valvular disease.
- These patients should be made aware of the symptoms and treatment options for HF.
- If you notice HF symptoms or signs, discontinue treatment.
- Post-marketing data showed that HF was more common in patients who received a daily total dose of 400mg, but there were cases among patients who took lower daily doses.
- Itraconazole, according to the American Heart Association (magnitude : major), may cause underlying myocardial dysfunction (magnitude : major).
- This should be avoided if you are treating serious fungal infections (AHA [Page 2016,]).
Hepatotoxicity:
- Rare cases of severe hepatotoxicity (including death and liver failure) have been reported. Some cases occurred within the first week of treatment.
- If you notice signs or symptoms of hepatotoxicity, discontinue treatment.
Hypersensitivity
- Reports of hypersensitivity reactions have been made. If you experience one, stop using the medication and get supportive care.
- Patients with a history or hypersensitivity to other Azoles should be cautious.
Neuropathy:
- Patients on long-term itraconazole have been known to develop peripheral neuropathy.
- If you notice any signs or symptoms of neuropathy, discontinue treatment immediately.
Cystic Fibrosis:
- Cystic Fibrosis patients who received the oral solution showed large differences in their pharmacokinetic parameters.
- Alternative therapies should be considered if they do not respond to therapy.
Hepatic impairment
- Patients with hepatic impairment should be cautious; closely monitor liver function.
- Patients with liver disease or elevated liver enzymes are not recommended.
Onychomycosis: [US Boxed Warning]:
- Patients with heart failure (HF), ventricular dysfunction (HF) or a history are not recommended for onychomycosis treatment.
- This patient population has seen cases of HF, peripheral and pulmonary embolisms.
- Before treating onychomycosis, the manufacturer suggests that nail specimens be tested for diagnosis.
Renal impairment
- Patients with impaired renal function should be cautious. There is limited information available. Dosage adjustment may be necessary.

Itraconazole: Drug Interaction

Risk Factor C (Monitor therapy)
Alosetron	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Alosetron.
Amphotericin B	Antifungal Agents (Azole Derivatives, Systemic) may diminish the therapeutic effect of Amphotericin B.
Benperidol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Benperidol.
Benzhydrocodone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Benzhydrocodone. Specifically, the concentration of hydrocodone may be increased.
Betamethasone (Ophthalmic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Betamethasone (Ophthalmic).
Bictegravir	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bictegravir.
Bortezomib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bortezomib.
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Bosentan	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bosentan. Management: Concomitant use of both a CYP2C9 inhibitor and a CYP3A inhibitor or a single agent that inhibits both enzymes with bosentan is likely to cause a large increase in serum concentrations of bosentan and is not recommended. See monograph for details.
Brentuximab Vedotin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be increased.
Brentuximab Vedotin	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be increased.
Brinzolamide	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brinzolamide.
Bromperidol	Itraconazole may increase the serum concentration of Bromperidol.
Budesonide (Nasal)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Nasal).
Budesonide (Oral Inhalation)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Oral Inhalation).
Buprenorphine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Buprenorphine.
Busulfan	Antifungal Agents (Azole Derivatives, Systemic) may increase the serum concentration of Busulfan. Isavuconazonium considerations are addressed in separate monographs.
Calcifediol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Calcifediol.
Cannabidiol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cannabidiol.
Cannabis	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be increased.
Celiprolol	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Celiprolol.
Cinacalcet	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cinacalcet.
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
CloZAPine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of CloZAPine. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Codeine	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Codeine.
Corticosteroids (Orally Inhaled)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Corticosteroids (Orally Inhaled). Management: Orally inhaled fluticasone propionate with a strong CYP3A4 inhibitor is not recommended. Exceptions: Beclomethasone (Oral Inhalation); Triamcinolone (Systemic).
Corticosteroids (Systemic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Corticosteroids (Systemic). Exceptions: MethylPREDNISolone; PrednisoLONE (Systemic); PredniSONE.
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Darolutamide	Inhibitors of CYP3A4 (Strong) and P-glycoprotein may increase the serum concentration of Darolutamide.
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
DexAMETHasone (Ophthalmic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of DexAMETHasone (Ophthalmic).
Dichlorphenamide	Antifungal Agents (Azole Derivatives, Systemic) may enhance the hypokalemic effect of Dichlorphenamide.
Dienogest	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dienogest.
Doxercalciferol	CYP3A4 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Doxercalciferol.
Dronabinol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dronabinol.
Dutasteride	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dutasteride.
Enfortumab Vedotin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Enfortumab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be increased.
Estrogen Derivatives	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Estrogen Derivatives.
Evogliptin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Evogliptin.
Fexofenadine	Itraconazole may increase the serum concentration of Fexofenadine.
Fosnetupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fostamatinib	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Fostamatinib.
Galantamine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Galantamine.
Gefitinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Gefitinib.
Grapefruit Juice	May decrease the serum concentration of Itraconazole. Grapefruit Juice may increase the serum concentration of Itraconazole.
HYDROcodone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of HYDROcodone.
Ifosfamide	CYP3A4 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Ifosfamide.
Imatinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Imatinib.
Imidafenacin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Imidafenacin.
Isoniazid	May decrease the serum concentration of Itraconazole.
Lacosamide	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lacosamide.
Levobupivacaine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Levobupivacaine.
Losartan	Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Losartan. Applicable Isavuconazonium considerations are addressed in separate monographs.
Lumefantrine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lumefantrine.
MedroxyPROGESTERone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of MedroxyPROGESTERone.
Meloxicam	Itraconazole may decrease the serum concentration of Meloxicam.
Meperidine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Meperidine.
Mirtazapine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Mirtazapine.
Naldemedine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Naldemedine.
Naldemedine	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Naldemedine.
Nalfurafine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Nalfurafine.
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Nintedanib	Combined Inhibitors of CYP3A4 and P-glycoprotein may increase the serum concentration of Nintedanib.
Ospemifene	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ospemifene.
Oxybutynin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Oxybutynin.
Parecoxib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Parecoxib.
Paricalcitol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Paricalcitol.
P-glycoprotein/ABCB1 Substrates	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Exceptions: Loperamide.
Pimecrolimus	CYP3A4 Inhibitors (Strong) may decrease the metabolism of Pimecrolimus.
Polatuzumab Vedotin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Polatuzumab Vedotin. Exposure to unconjugated MMAE, the cytotoxic small molecule component of polatuzumab vedotin, may be increased.
Pranlukast	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Pranlukast.
Pravastatin	Itraconazole may increase the serum concentration of Pravastatin.
Praziquantel	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Praziquantel.
PrednisoLONE (Systemic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of PrednisoLONE (Systemic).
PredniSONE	CYP3A4 Inhibitors (Strong) may increase the serum concentration of PredniSONE.
Propafenone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Propafenone. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Prucalopride	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Prucalopride.
QT-prolonging Agents (Highest Risk)	QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Ramelteon	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ramelteon.
Repaglinide	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Repaglinide. Management: The addition of a CYP2C8 inhibitor to this drug combination may substantially increase the magnitude of increase in repaglinide exposure.
Retapamulin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Retapamulin. Management: Avoid this combination in patients less than 2 years old. No action is required in other populations.
RifAXIMin	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of RifAXIMin.
Rilpivirine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Rilpivirine.
RomiDEPsin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of RomiDEPsin.
Rosuvastatin	Itraconazole may increase the serum concentration of Rosuvastatin.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Sibutramine	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Sibutramine. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Sibutramine.
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
SORAfenib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of SORAfenib.
Tacrolimus (Topical)	Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Tacrolimus (Topical). Applicable Isavuconazonium considerations are addressed in separate monographs.
Tasimelteon	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tasimelteon.
Tegaserod	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Tegaserod.
Tetrahydrocannabinol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tetrahydrocannabinol.
Tetrahydrocannabinol and Cannabidiol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tetrahydrocannabinol and Cannabidiol.
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
TraMADol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of TraMADol.
Upadacitinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Upadacitinib.
Vilanterol	May increase the serum concentration of CYP3A4 Inhibitors (Strong).
VinBLAStine	Itraconazole may increase the serum concentration of VinBLAStine.
Vindesine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Vindesine.
Vinorelbine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Vinorelbine.
Vitamin K Antagonists (eg, warfarin	Itraconazole may increase the serum concentration of Vitamin K Antagonists.
Zolpidem	Itraconazole may increase the serum concentration of Zolpidem.
Risk Factor D (Consider therapy modification)
Abemaciclib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Abemaciclib. Management: In patients taking abemaciclib at a dose of 200 mg or 150 mg twice daily, reduce the dose to 100 mg twice daily when combined with strong CYP3A4 inhibitors. In patients taking abemaciclib 100 mg twice daily, decrease the dose to 50 mg twice daily.
Afatinib	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Afatinib. Management: Reduce afatinib by 10 mg if not tolerated. Some non-US labeling recommends avoiding combination if possible. If used, administer the P-gp inhibitor simultaneously with or after the dose of afatinib.
Alitretinoin (Systemic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Alitretinoin (Systemic). Management: Consider reducing the alitretinoin dose to 10 mg when used together with strong CYP3A4 inhibitors. Monitor for increased alitretinoin effects/toxicities if combined with a strong CYP3A4 inhibitor.
Almotriptan	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Almotriptan. Management: Limit initial almotriptan adult dose to 6.25 mg and maximum adult dose to 12.5 mg/24-hrs when used with a strong CYP3A4 inhibitor. Avoid concurrent use in patients with impaired hepatic or renal function.
Antacids	May decrease the serum concentration of Itraconazole. Antacids may increase the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction.
Apixaban	Inhibitors of CYP3A4 (Strong) and P-glycoprotein may increase the serum concentration of Apixaban. Management: US labeling recommends a 50% apixaban dose reduction in patients who would otherwise receive 5 or 10 mg twice daily, and avoiding in patients who would otherwise receive 2.5 mg twice daily. Canadian labeling lists any combined use as contraindicated.
ARIPiprazole	CYP3A4 Inhibitors (Strong) may increase the serum concentration of ARIPiprazole. Management: See full interaction monograph for details.
ARIPiprazole Lauroxil	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of ARIPiprazole Lauroxil. Management: Please refer to the full interaction monograph for details concerning the recommended dose adjustments.
AtorvaSTATin	Itraconazole may increase the serum concentration of AtorvaSTATin. Management: Limit atorvastatin to a maximum adult dose of 20 mg/day in patients receiving itraconazole. Assess clinical response to ensure that the lowest necessary dose of atorvastatin is used. Consider use of fluva-, rosuva-, pitava-, or pravastatin when possible.
Bedaquiline	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bedaquiline. Management: Limit duration of concurrent use of bedaquiline with CYP3A4 inhibitors to no more than 14 days, unless the benefit of continued use outweighs the possible risks. Monitor for toxic effects of bedaquiline. Exceptions discussed in separate monographs.
Betrixaban	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Betrixaban. Management: Decrease the adult betrixaban dose to an initial single dose of 80 mg followed by 40 mg once daily if combined with a P-glycoprotein inhibitor.
Bilastine	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Bilastine. Management: Consider alternatives when possible; bilastine should be avoided in patients with moderate to severe renal insufficiency who are receiving p-glycoprotein inhibitors.
Brexpiprazole	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brexpiprazole. Management: Reduce brexpiprazole dose 50% with strong CYP3A4 inhibitors; reduce to 25% of usual if used with both a moderate CYP3A4 inhibitor and a CYP2D6 inhibitor in patients not being treated for MDD, or strong CYP3A4 inhibitor used in a CYP2D6 poor metabolizer.
Brigatinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brigatinib. Management: Avoid concurrent use of brigatinib with strong CYP3A4 inhibitors when possible. If combination cannot be avoided, reduce the brigatinib dose by approximately 50%, rounding to the nearest tablet strength (ie, from 180 mg to 90 mg, or from 90 mg to 60 mg).
Budesonide (Topical)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Topical). Management: Per US prescribing information, avoid this combination. Canadian product labeling does not recommend strict avoidance. If combined, monitor for excessive glucocorticoid effects as budesonide exposure may be increased.
BusPIRone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of BusPIRone. Management: Limit the buspirone dose to 2.5 mg daily and monitor patients for increased buspirone effects/toxicities if combined with strong CYP3A4 inhibitors.
Cabazitaxel	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cabazitaxel. Management: Concurrent use of cabazitaxel with strong inhibitors of CYP3A4 should be avoided when possible. If such a combination must be used, consider a 25% reduction in the cabazitaxel dose.
Cabozantinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cabozantinib. Management: Avoid use of a strong CYP3A4 inhibitor with cabozantinib if possible. If combined, cabozantinib dose adjustments are recommended and vary based on the cabozantinib product used and the indication for use. See monograph for details.
Calcium Channel Blockers	Antifungal Agents (Azole Derivatives, Systemic) may enhance the adverse/toxic effect of Calcium Channel Blockers. Specifically, itraconazole may enhance the negative inotropic effects of verapamil or diltiazem. Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Calcium Channel Blockers. Fluconazole and isavuconazonium likely exert weaker effects than other azoles and are addressed in separate monographs. Management: Concurrent use of felodipine or nisoldipine with itraconazole is specifically contraindicated. Frequent monitoring is warranted with any such combination; calcium channel blocker dose reductions may be required. Exceptions: Clevidipine.
Cardiac Glycosides	Itraconazole may increase the serum concentration of Cardiac Glycosides. Management: Consider preemptive cardiac glycoside dose adjustments with initiation / changes / discontinuation of itraconazole.
Cariprazine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cariprazine. Management: Cariprazine dose reductions of 50% are required; specific recommended management varies slightly for those stable on cariprazine versus those just starting cariprazine. See prescribing information or full interaction monograph for details.
Ceritinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ceritinib. Management: If such combinations cannot be avoided, the ceritinib dose should be reduced by approximately one-third (to the nearest 150 mg). Resume the prior ceritinib dose after cessation of the strong CYP3A4 inhibitor. Exceptions discussed in separate monographs.
Cilostazol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cilostazol. Management: Consider reducing the cilostazol dose to 50 mg twice daily in adult patients who are also receiving strong inhibitors of CYP3A4.
Cobicistat	Itraconazole may increase the serum concentration of Cobicistat. Cobicistat may increase the serum concentration of Itraconazole. Management: Limit itraconazole to a maximum adult dose of 200 mg/day in patients treated with the elvitegravir/cobicistat/emtricitabine/tenofovir combination product. Dosing recommendations for other cobicistat-containing products are not available.
Colchicine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Colchicine. Management: Colchicine is contraindicated in patients with impaired renal or hepatic function who are also receiving a strong CYP3A4 inhibitor. In those with normal renal and hepatic function, reduce colchicine dose as directed. See full monograph for details.
Colchicine	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Colchicine. Colchicine distribution into certain tissues (e.g., brain) may also be increased. Management: Colchicine is contraindicated in patients with impaired renal or hepatic function who are also receiving a p-glycoprotein inhibitor. In those with normal renal and hepatic function, reduce colchicine dose as directed. See full monograph for details.
Copanlisib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Copanlisib. Management: If concomitant use of copanlisib and strong CYP3A4 inhibitors cannot be avoided, reduce the copanlisib dose to 45 mg. Monitor patients for increased copanlisib effects/toxicities.
Crizotinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Crizotinib. Management: Avoid concomitant use of crizotinib and strong CYP3A4 inhibitors whenever possible. If combined use cannot be avoided, decrease the crizotinib dose to 250 mg daily. Exceptions are discussed in separate monographs.
CycloSPORINE (Systemic)	Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of CycloSPORINE (Systemic). Fluconazole and isavuconazonium considerations are addressed in separate monographs.
CycloSPORINE (Systemic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of CycloSPORINE (Systemic).
CYP3A4 Inhibitors (Strong)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
CYP3A4 Substrates (High risk with Inhibitors)	CYP3A4 Inhibitors (Strong) may decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Exceptions: Alitretinoin (Systemic); AmLODIPine; Benzhydrocodone; Buprenorphine; Gefitinib; HYDROcodone; Mirtazapine; Praziquantel; Telithromycin; Vinorelbine.
Dabigatran Etexilate	P-glycoprotein/ABCB1 Inhibitors may increase serum concentrations of the active metabolite(s) of Dabigatran Etexilate. Management: Dabigatran dose reductions may be needed. Specific recommendations vary considerably according to US vs Canadian labeling, specific P-gp inhibitor, renal function, and indication for dabigatran treatment. Refer to full monograph or dabigatran labeling.
Daclatasvir	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Daclatasvir. Management: Decrease the daclatasvir dose to 30 mg once daily if combined with a strong CYP3A4 inhibitor. No dose adjustment is needed when daclatasvir is used with darunavir/cobicistat.
Darunavir	May increase the serum concentration of Itraconazole. Itraconazole may increase the serum concentration of Darunavir. Management: Limit the adult maximum itraconazole dose to 200 mg/day in patients receiving darunavir/ritonavir.
Dasatinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dasatinib. Management: This combination should be avoided if possible. If combined, dasatinib dose reductions are recommended. See full monograph for details. Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Deflazacort	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Deflazacort. Management: Administer one third of the recommended deflazacort dose when used together with a strong or moderate CYP3A4 inhibitor.
Delamanid	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Delamanid. Management: Increase ECG monitoring frequency if delamanid is combined with strong CYP3A4 inhibitors due to the risk for QTc interval prolongation. Continue frequent ECG assessments throughout full delamanid treatment period. Exceptions discussed separately.
Didanosine	May decrease the absorption of Antifungal Agents (Azole Derivatives, Systemic). Enteric coated didanosine capsules are not expected to affect these antifungals.
DOCEtaxel	CYP3A4 Inhibitors (Strong) may increase the serum concentration of DOCEtaxel. Management: Avoid the concomitant use of docetaxel and strong CYP3A4 inhibitors when possible. If combined use is unavoidable, consider a 50% docetaxel dose reduction and monitor for increased docetaxel toxicities.
DOXOrubicin (Conventional)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to strong CYP3A4 inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.
DOXOrubicin (Conventional)	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to P-glycoprotein inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.
Drospirenone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Drospirenone. Management: Drospirenone use is contraindicated specifically when the strong CYP3A4 inhibitors atazanavir and cobicistat are administered concurrently. Caution should be used when drospirenone is coadministered with other strong CYP3A4 inhibitors.
Duvelisib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Duvelisib. Management: Reduce the dose of duvelisib to 15 mg twice a day when used together with a strong CYP3A4 inhibitor.
Edoxaban	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Edoxaban. Management: See full monograph for details. Reduced doses are recommended for patients receiving edoxaban for venous thromboembolism in combination with certain P-gp inhibitors. Similar dose adjustment is not recommended for edoxaban use in atrial fibrillation.
Elagolix	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Elagolix. Management: Use of the elagolix 200 mg twice daily dose with a strong CYP3A4 inhibitor for longer than 1 month is not recommended. Limit combined use of the elagolix 150 mg once daily dose with a strong CYP3A4 inhibitor to a maximum of 6 months.
Eliglustat	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eliglustat. Management: Use should be avoided under some circumstances. See full drug interaction monograph for details.
Elvitegravir	Itraconazole may increase the serum concentration of Elvitegravir. Management: Limit itraconazole to a maximum dose of 200 mg/day in patients who are being treated with the elvitegravir-containing products.
Encorafenib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Encorafenib. Management: Avoid concomitant use of encorafenib and strong CYP3A4 inhibitors whenever possible. If concomitant administration is unavoidable, decrease the encorafenib dose. See monograph for details.
Entrectinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Entrectinib. Management: Avoid strong CYP3A4 inhibitors during treatment with entrectinib. Reduce dose to 100 mg/day if combination cannot be avoided in adults and those 12 yrs of age or older with a BSA of at least 1.5 square meters. No alternative dosing provided for others.
Erdafitinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Erdafitinib. Management: Avoid concomitant use of erdafitinib and strong CYP3A4 inhibitors when possible. If combined, monitor closely for erdafitinib adverse reactions and consider dose modifications accordingly.
Erlotinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Erlotinib. Management: Avoid use of this combination when possible. When the combination must be used, monitor the patient closely for the development of severe adverse reactions, and if such severe reactions occur, reduce the erlotinib dose (in 50 mg decrements).
Eszopiclone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eszopiclone. Management: Limit the eszopiclone dose to 2 mg daily when combined with strong CYP3A4 inhibitors and monitor for increased eszopiclone effects and toxicities (eg, somnolence, drowsiness, CNS depression).
Etizolam	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Etizolam. Management: Consider use of lower etizolam doses when using this combination; specific recommendations concerning dose adjustment are not available. Monitor clinical response to the combination closely.
Etravirine	Antifungal Agents (Azole Derivatives, Systemic) may increase the serum concentration of Etravirine. Applicable Isavuconazonium considerations are addressed in separate monographs. Etravirine may decrease the serum concentration of Antifungal Agents (Azole Derivatives, Systemic). This would be anticipated with itraconazole or ketoconazole. Etravirine may increase the serum concentration of Antifungal Agents (Azole Derivatives, Systemic). This would be anticipated with voriconazole. Management: Monitor for increased effects/toxicity of etravirine. Antifungal dose adjustment may be needed for ketoconazole, itraconazole, or posaconazole but specific dosing guidelines are lacking.
Fedratinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Fedratinib. Management: Consider alternatives when possible. If used together, decrease fedratinib dose to 200 mg/day. After the inhibitor is stopped, increase fedratinib to 300 mg/day for the first 2 weeks and then to 400 mg/day as tolerated.
FentaNYL	CYP3A4 Inhibitors (Strong) may increase the serum concentration of FentaNYL. Management: Monitor patients closely for several days following initiation of this combination, and adjust fentanyl dose as necessary.
Fesoterodine	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Fesoterodine. Management: Avoid fesoterodine doses greater than 4 mg daily in adult patients who are also receiving strong CYP3A4 inhibitors.
Fluticasone (Oral Inhalation)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Fluticasone (Oral Inhalation). Management: Use of orally inhaled fluticasone propionate with strong CYP3A4 inhibitors is not recommended. Use of orally inhaled fluticasone furoate with strong CYP3A4 inhibitors should be done with caution. Monitor patients using such a combination more closely.
Fosamprenavir	Itraconazole may increase serum concentrations of the active metabolite(s) of Fosamprenavir. Specifically, amprenavir concentrations may be increased. Fosamprenavir may increase the serum concentration of Itraconazole. Management: Limit the adult maximum itraconazole dose to 200 mg/day with fosamprenavir/ritonavir. In patients receiving fosamprenavir without ritonavir, patients receiving greater than 400 mg/day itraconazole may also require dose reduction.
Gilteritinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Gilteritinib. Management: Consider alternatives to the use of a strong CYP3A4 inhibitor with gilteritinib. If the combination cannot be avoided, monitor more closely for evidence of gilteritinib toxicities.
Glasdegib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Glasdegib. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor closely for evidence of QT interval prolongation and other adverse reactions to glasdegib.
GuanFACINE	CYP3A4 Inhibitors (Strong) may increase the serum concentration of GuanFACINE. Management: Reduce the guanfacine dose by 50% when initiating this combination.
Histamine H2 Receptor Antagonists	May increase the serum concentration of Itraconazole. Histamine H2 Receptor Antagonists may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any histamine H2 receptor antagonists (H2RAs). Exposure to Tolsura brand itraconazole may be increased by H2RAs; consider itraconazole dose reduction.
Iloperidone	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Iloperidone. Specifically, concentrations of the metabolites P88 and P95 may be increased. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Iloperidone. Management: Reduce iloperidone dose by half when administered with a strong CYP3A4 inhibitor.
Indinavir	Itraconazole may increase the serum concentration of Indinavir. Indinavir may increase the serum concentration of Itraconazole. Management: Reduce the normal indinavir adult dose to 600 mg every 8 hours when given with itraconazole. Monitor for increased systemic effects (including adverse/toxic effects) of itraconazole.
Istradefylline	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Istradefylline. Management: Limit the maximum istradefylline dose to 20 mg daily when combined with strong CYP3A4 inhibitors and monitor for increased istradefylline effects/toxicities.
Ivacaftor	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ivacaftor. Management: Ivacaftor dose reductions are required; consult full monograph content for productspecific recommendations.
Ixabepilone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ixabepilone.
Larotrectinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Larotrectinib. Management: Avoid use of strong CYP3A4 inhibitors with larotrectinib. If this combination cannot be avoided, reduce the larotrectinib dose by 50%. Increase to previous dose after stopping the inhibitor after a period of 3 to 5 times the inhibitor half-life.
Levomilnacipran	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Levomilnacipran. Management: Do not exceed a maximum adult levomilnacipran dose of 80 mg/day in patients also receiving strong CYP3A4 inhibitors.
Lopinavir	May increase the serum concentration of Itraconazole. Management: Limit the adult maximum itraconazole dose to 200 mg/day in patients receiving lopinavir/ritonavir.
Lorlatinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lorlatinib. Management: Avoid use of lorlatinib with strong CYP3A4 inhibitors. If the combination cannot be avoided, reduce the lorlatinib dose from 100 mg once daily to 75 mg once daily, or from 75 mg once daily to 50 mg once daily.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Manidipine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Manidipine. Management: Consider avoiding concomitant use of manidipine and strong CYP3A4 inhibitors. If combined, monitor closely for increased manidipine effects and toxicities. Manidipine dose reductions may be required.
Maraviroc	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Maraviroc. Management: Reduce the adult dose of maraviroc to 150 mg twice daily when used with a strong CYP3A4 inhibitor. Do not use maraviroc with strong CYP3A4 inhibitors in patients with Clcr less than 30 mL/min.
MethylPREDNISolone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of MethylPREDNISolone. Management: Consider methylprednisolone dose reduction in patients receiving strong CYP3A4 inhibitors and monitor for increased steroid related adverse effects.
Midostaurin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Midostaurin. Management: Seek alternatives to the concomitant use of midostaurin and strong CYP3A4 inhibitors if possible. If concomitant use cannot be avoided, monitor patients for increased risk of adverse reactions. Exceptions are discussed in separate monographs.
MiFEPRIStone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of MiFEPRIStone. Management: Limit mifepristone adult dose, when used for treatment of hyperglycemia in Cushing's syndrome, to a maximum of 900 mg/day when combined with a strong CYP3A4 inhibitor. Monitor for increased mifepristone toxicity regardless of dose or indication.
MiFEPRIStone	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.
Mirodenafil	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Mirodenafil. Management: Consider using a lower dose of mirodenafil when used with strong CYP3A4 inhibitors. Monitor for increased mirodenafil effects/toxicities with the use of this combination.
Nilotinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Nilotinib. Management: Avoid if possible. If combination needed, decrease nilotinib to 300 mg once/day for patients with resistant or intolerant Ph+ CML or to 200 mg once/day for patients with newly diagnosed Ph+ CML in chronic phase. Exceptions discussed in separate monograph.
Olaparib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Olaparib. Management: Avoid use of strong CYP3A4 inhibitors in patients being treated with olaparib, if possible. If such concurrent use cannot be avoided, the dose of olaparib should be reduced to 100 mg twice daily.
OxyCODONE	CYP3A4 Inhibitors (Strong) may enhance the adverse/toxic effect of OxyCODONE. CYP3A4 Inhibitors (Strong) may increase the serum concentration of OxyCODONE. Serum concentrations of the active metabolite oxymorphone may also be increased.
Paliperidone	Itraconazole may enhance the QTc-prolonging effect of Paliperidone. Itraconazole may decrease the metabolism of Paliperidone.
Panobinostat	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Panobinostat. Management: Reduce the panobinostat dose to 10 mg when it must be used with a strong CYP3A4 inhibitor.
Pexidartinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Pexidartinib. Management: Avoid use of pexidartinib with strong CYP3A4 inhibitors if possible. If combined use cannot be avoided, the pexidartinib dose should be reduced. Decrease 800 mg or 600 mg daily doses to 200 mg twice daily. Decrease doses of 400 mg/day to 200 mg/day.
Pimavanserin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Pimavanserin. Management: Decrease the pimavanserin dose to 10 mg daily when combined with strong CYP3A4 inhibitors.
Piperaquine	CYP3A4 Inhibitors (Strong) may enhance the QTc-prolonging effect of Piperaquine. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Piperaquine. Management: Avoid concomitant use of piperaquine and strong CYP3A4 inhibitors when possible. If the combination cannot be avoided, frequent ECG monitoring is recommended due to the risk for QTc prolongation. Exceptions are discussed separately.
PONATinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of PONATinib. Management: Per ponatinib U.S. prescribing information, the adult starting dose of ponatinib should be reduced to 30 mg daily during treatment with any strong CYP3A4 inhibitor.
Proton Pump Inhibitors	May increase the serum concentration of Itraconazole. Proton Pump Inhibitors may decrease the serum concentration of Itraconazole. Management: Exposure to Tolsura brand itraconazole may be increased by PPIs; consider itraconazole dose reduction. Exposure to Sporanox brand itraconazole capsules may be decreased by PPIs. Give Sporanox brand itraconazole at least 2 hrs before or 2 hrs after PPIs
QUEtiapine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of QUEtiapine. Management: In quetiapine treated patients, reduce quetiapine to one-sixth of regular dose after starting strong CYP3A4 inhibitor. In those on strong CYP3A4 inhibitors, start quetiapine at lowest dose and up-titrate as needed. Exceptions discussed separately.
Reboxetine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Reboxetine.
Ribociclib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ribociclib. Management: Avoid use of ribociclib with strong CYP3A4 inhibitors when possible; if combined use cannot be avoided, reduce ribociclib dose to 400 mg once daily. Exceptions are discussed in separate monographs.
Rifamycin Derivatives	Antifungal Agents (Azole Derivatives, Systemic) may increase the serum concentration of Rifamycin Derivatives. Only rifabutin appears to be affected. Rifamycin Derivatives may decrease the serum concentration of Antifungal Agents (Azole Derivatives, Systemic). Management: Avoid these combinations when possible. Voriconazole and isavuconazonium are considered contraindicated.
Riociguat	Itraconazole may increase the serum concentration of Riociguat. Management: Consider starting with a reduced riociguat dose of 0.5 mg three times a day. Patients receiving such a combination should also be monitored extra closely for signs or symptoms of hypotension.
Ritonavir	May increase the serum concentration of Itraconazole. Management: Limit the adult maximum itraconazole dose to 200 mg/day in patients receiving ritonavir.
Ruxolitinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ruxolitinib. Management: This combination should be avoided under some circumstances. See monograph for details.
Saquinavir	Itraconazole may increase the serum concentration of Saquinavir. Saquinavir may increase the serum concentration of Itraconazole. Management: Limit the adult maximum itraconazole dose to 200 mg/day in patients receiving saquinavir/ritonavir.
SAXagliptin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of SAXagliptin. Management: Limit the saxagliptin dose to 2.5 mg daily when combined with strong CYP3A4 inhibitors. When using the saxagliptin combination products saxagliptin/dapagliflozin or saxagliptin/dapagliflozin/metformin, avoid use with strong CYP3A4 inhibitors.
Sildenafil	Itraconazole may increase the serum concentration of Sildenafil. Management: Concurrent itraconazole is not recommended when sildenafil is used for treatment of pulmonary arterial hypertension. If sildenafil is used to treat erectile dysfunction, an initial dose of 25 mg is recommended with concurrent itraconazole.
Sirolimus	Itraconazole may increase the serum concentration of Sirolimus. Management: Sirolimus dose adjustments will likely be needed when starting/stopping any azole antifungal. Clinical data suggest sirolimus (adult) dose reductions of 50-90% will be needed when starting an azole antifungal, but specific guidelines are lacking.
Solifenacin	Itraconazole may increase the serum concentration of Solifenacin. Management: Limit solifenacin doses to 5 mg daily when combined with itraconazole. Do not use solifenacin with itraconazole, or for 2 weeks after itraconazole discontinuation, in patients with moderate to severe hepatic impairment or severe renal impairment.
Stiripentol	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.
SUFentanil	CYP3A4 Inhibitors (Strong) may increase the serum concentration of SUFentanil. Management: If a strong CYP3A4 inhibitor is initiated in a patient on sufentanil, consider a sufentanil dose reduction and monitor for increased sufentanil effects and toxicities (eg, respiratory depression).
SUNItinib	Itraconazole may increase the serum concentration of SUNItinib. Management: Avoid when possible. If such a combination cannot be avoided, sunitinib dose decreases are recommended, and vary by indication. See full monograph for details.
Tacrolimus (Systemic	Itraconazole may increase the serum concentration of Tacrolimus (Systemic). Management: Monitor tacrolimus concentrations closely and adjust dose as necessary when concomitantly administered with itraconazole. Tacrolimus dose reductions will likely be required. The magnitude of this interaction may be greater in older patients.
Tadalafil	Itraconazole may increase the serum concentration of Tadalafil.
Talazoparib	Itraconazole may increase the serum concentration of Talazoparib. Management: If concurrent use cannot be avoided, reduce talazoparib dose to 0.75 mg once daily. After a period of 3 to 5 times the half-life of itraconazole, increase the talazoparib dose to the dose used before initiation of itraconazole.
Tezacaftor	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tezacaftor. Management: When combined with strong CYP3A4 inhibitors, tezacaftor/ivacaftor should be administered in the morning, twice a week, approximately 3 to 4 days apart. No evening doses of ivacaftor alone should be administered.
Thiotepa	CYP3A4 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Thiotepa. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Thiotepa. Management: Thiotepa prescribing information recommends avoiding concomitant use of thiotepa and strong CYP3A4 inhibitors. If concomitant use is unavoidable, monitor for adverse effects and decreased efficacy.
Tipranavir	May increase the serum concentration of Itraconazole. Management: Limit itraconazole adult maximum dose to 200 mg/day in patients treated with tipranavir.
Tofacitinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tofacitinib. Management: Tofacitinib dose reductions are recommended when combined with strong CYP3A4 inhibitors. Recommended dose adjustments vary by tofacitinib formulation and therapeutic indication. See full monograph for details.
Tolterodine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tolterodine. Management: The maximum recommended adult dose of tolterodine is 2 mg/day when used together with a strong CYP3A4 inhibitor.
Toremifene	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Toremifene. Management: Use of toremifene with strong CYP3A4 inhibitors should be avoided if possible. If coadministration is necessary, monitor for increased toremifene toxicities, including QTc interval prolongation. Exceptions are discussed in separate monograph.
TraZODone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of TraZODone. Management: Consider the use of a lower trazodone dose and monitor for increased trazodone effects (eg, sedation, QTc prolongation) if combined with strong CYP3A4 inhibitors.
Valbenazine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Valbenazine. Management: Reduce the valbenazine dose to 40 mg daily when combined with strong CYP3A4 inhibitors.
Vardenafil	Itraconazole may increase the serum concentration of Vardenafil. Management: Limit vardenafil to a max of 5 mg/24 hours in patients receiving itraconazole 200 mg/day, and a max of 2.5 mg/24 hours in patients receiving itraconazole 400 mg/day. Itraconazole labeling and Staxyn brand of vardenafil both recommend avoiding this combo.
Vemurafenib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Vemurafenib. Management: Avoid concurrent use of vemurafenib with strong CYP3A4 inhibitors when possible. Consider use of an alternative that is not a strong inhibitor of CYP3A4 as clinically appropriate.
Venetoclax	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Venetoclax. Management: This combination is contraindicated during venetoclax initiation and ramp-up in patients with CLL/SLL. Reduced venetoclax doses are required during ramp-up for patients with AML, and reduced doses are required for all patients during maintenance therapy.
Venetoclax	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Venetoclax. Management: Consider a venetoclax dose reduction by at least 50% in patients requiring concomitant treatment with P-glycoprotein (P-gp) inhibitors.
Vilazodone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Vilazodone. Management: Limit maximum adult vilazodone dose to 20 mg daily in patients receiving strong CYP3A4 inhibitors. The original vilazodone dose can be resumed following discontinuation of the strong CYP3A4 inhibitor.
VinCRIStine	Itraconazole may enhance the adverse/toxic effect of VinCRIStine. Itraconazole may increase the serum concentration of VinCRIStine.
Voxelotor	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Voxelotor. Management: Avoid concomitant use of voxelotor and strong CYP3A4 inhibitors. If concomitant use is unavoidable, reduce the voxelotor dose to 1,000 mg once daily.
Zanubrutinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Zanubrutinib. Management: Decrease the zanubrutinib dose to 80 mg once daily during coadministration with a strong CYP3A4 inhibitor. Further dose adjustments may be required for zanubrutinib toxicities, refer to prescribing information for details.
Zopiclone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Zopiclone. Management: The initial starting adult dose of zopiclone should not exceed 3.75 mg if combined with a strong CYP3A4 inhibitor. Monitor patients for signs and symptoms of zopiclone toxicity if these agents are combined.
Zuclopenthixol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Zuclopenthixol. Management: Consider zuclopenthixol dosage reduction with concomitant use of a strong CYP3A4 inhibitor (eg, ketoconazole) in poor CYP2D6 metabolizers or with strong CYP2D6 inhibitors (eg, paroxetine). Monitor for increased zuclopenthixol levels/toxicity.
Risk Factor X (Avoid combination)
Acalabrutinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Acalabrutinib.
Ado-Trastuzumab Emtansine	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Ado-Trastuzumab Emtansine. Specifically, strong CYP3A4 inhibitors may increase concentrations of the cytotoxic DM1 component.
Alfuzosin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Alfuzosin.
Aliskiren	Itraconazole may increase the serum concentration of Aliskiren.
ALPRAZolam	Itraconazole may increase the serum concentration of ALPRAZolam.
Aprepitant	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Aprepitant.
Astemizole	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Astemizole. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Asunaprevir	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Asunaprevir.
Avanafil	Itraconazole may increase the serum concentration of Avanafil.
Avapritinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Avapritinib.
Axitinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Axitinib. Management: Avoid concurrent use of axitinib with any strong CYP3A inhibitor whenever possible. If a strong CYP3A inhibitor must be used with axitinib, a 50% axitinib dose reduction is recommended.
Barnidipine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Barnidipine.
Blonanserin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Blonanserin.
Bosutinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bosutinib.
Bromocriptine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bromocriptine.
Budesonide (Systemic)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Systemic).
Cisapride	Itraconazole may increase the serum concentration of Cisapride.
Clobetasone	Itraconazole may increase the serum concentration of Clobetasone.
Cobimetinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cobimetinib.
Conivaptan	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Conivaptan.
Conivaptan	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
CYP3A4 Inducers (Strong)	May decrease the serum concentration of Itraconazole.
Dabrafenib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dabrafenib.
Dapoxetine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dapoxetine.
Dihydroergotamine	Itraconazole may increase the serum concentration of Dihydroergotamine.
Disopyramide	Itraconazole may increase the serum concentration of Disopyramide.
Dofetilide	Itraconazole may increase the serum concentration of Dofetilide.
Domperidone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Domperidone. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Dronedarone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dronedarone. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Efavirenz	May decrease the serum concentration of Itraconazole.
Eletriptan	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eletriptan.
Eplerenone	Itraconazole may increase the serum concentration of Eplerenone.
Ergoloid Mesylates	Itraconazole may increase the serum concentration of Ergoloid Mesylates.
Ergonovine	Itraconazole may increase the serum concentration of Ergonovine.
Ergotamine	Itraconazole may increase the serum concentration of Ergotamine.
Estazolam	Itraconazole may increase the serum concentration of Estazolam.
Everolimus	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Everolimus.
Felodipine	Itraconazole may increase the serum concentration of Felodipine.
Flibanserin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Flibanserin.
Fluticasone (Nasal)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Fluticasone (Nasal).
Fosaprepitant	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Fosaprepitant.
Fusidic Acid (Systemic)	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Halofantrine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Halofantrine. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Ibrutinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ibrutinib. Management: Avoid concomitant use of ibrutinib and strong CYP3A4 inhibitors. If a strong CYP3A4 inhibitor must be used short-term (eg, anti-infectives for 7 days or less), interrupt ibrutinib therapy until the strong CYP3A4 inhibitor is discontinued.
Idelalisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Irinotecan Products	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, serum concentrations of SN-38 may be increased. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Irinotecan Products.
Isavuconazonium Sulfate	CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Isavuconazonium Sulfate. Specifically, CYP3A4 Inhibitors (Strong) may increase isavuconazole serum concentrations. Management: Combined use is considered contraindicated per US labeling. Lopinavir/ritonavir (and possibly other uses of ritonavir doses less than 400 mg every 12 hours) is treated as a possible exception to this contraindication despite strongly inhibiting CYP3A4.
Ivabradine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ivabradine.
Ivosidenib	Itraconazole may increase the serum concentration of Ivosidenib. Ivosidenib may decrease the serum concentration of Itraconazole.
Lapatinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lapatinib. Management: If an overlap in therapy cannot be avoided, consider reducing lapatinib adult dose to 500 mg/day during, and within 1 week of completing, treatment with the strong CYP3A4 inhibitor.
Lefamulin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin tablets and strong inhibitors of CYP3A4.
Lemborexant	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lemborexant.
Lercanidipine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lercanidipine.
Lomitapide	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lomitapide.
Lovastatin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lovastatin.
Lumacaftor	May decrease the serum concentration of Itraconazole.
Lumateperone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lumateperone.
Lurasidone	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lurasidone.
Macitentan	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Macitentan.
Methadone	Itraconazole may increase the serum concentration of Methadone.
Methylergonovine	Itraconazole may increase the serum concentration of Methylergonovine.
Midazolam	Itraconazole may increase the serum concentration of Midazolam. Management: Oral midazolam is contraindicated. Use intravenous midazolam with great caution in patients receiving itraconazole, employing reduced initial doses whenever possible and monitoring closely for enhanced and prolonged effects.
Mizolastine	Antifungal Agents (Azole Derivatives, Systemic) may increase the serum concentration of Mizolastine.
Naloxegol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Naloxegol.
Neratinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Neratinib.
Nevirapine	May decrease the serum concentration of Itraconazole.
NiMODipine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of NiMODipine.
Nisoldipine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Nisoldipine.
Palbociclib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Palbociclib.
PAZOPanib	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of PAZOPanib.
Pimozide	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Pimozide.
QuiNIDine	Itraconazole may increase the serum concentration of QuiNIDine.
Radotinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Radotinib.
Ranolazine	Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Ranolazine. Fluconazole and isavuconazonium considerations are addressed in separate monographs.
Ranolazine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ranolazine.
Red Yeast Rice	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Red Yeast Rice. Specifically, concentrations of lovastatin and related compounds found in Red Yeast Rice may be increased.
Regorafenib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Regorafenib.
Rivaroxaban	Inhibitors of CYP3A4 (Strong) and P-glycoprotein may increase the serum concentration of Rivaroxaban.
Rupatadine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Rupatadine.
Saccharomyces boulardii	Antifungal Agents (Systemic, Oral) may diminish the therapeutic effect of Saccharomyces boulardii.
Salmeterol	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Salmeterol.
Silodosin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Silodosin.
Simeprevir	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Simeprevir.
Simvastatin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Simvastatin.
Sonidegib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Sonidegib.
Suvorexant	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Suvorexant.
Tamsulosin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tamsulosin.
Telithromycin	Itraconazole may increase the serum concentration of Telithromycin. Telithromycin may increase the serum concentration of Itraconazole.
Temsirolimus	Itraconazole may increase serum concentrations of the active metabolite(s) of Temsirolimus.
Terfenadine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Terfenadine. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Ticagrelor	CYP3A4 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Ticagrelor. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ticagrelor.
Tolvaptan	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Tolvaptan.
Topotecan	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Topotecan.
Trabectedin	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Trabectedin.
Triazolam	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Triazolam.
Ubrogepant	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ubrogepant.
Udenafil	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Udenafil.
Ulipristal	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ulipristal. Management: This is specific for when ulipristal is being used for signs/symptoms of uterine fibroids (Canadian indication). When ulipristal is used as an emergency contraceptive, patients receiving this combo should be monitored for ulipristal toxicity.
VinCRIStine (Liposomal)	CYP3A4 Inhibitors (Strong) may increase the serum concentration of VinCRIStine (Liposomal).
VinCRIStine (Liposomal)	P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of VinCRIStine (Liposomal).
Vinflunine	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Vinflunine.
Vorapaxar	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Vorapaxar.

Monitoring parameters:

Liver function in patients with preexisting hepatic dysfunction, and in all patients as clinically indicated;
renal function;
signs/symptoms of HF

For invasive aspergillosis (treatment or prolonged prophylaxis), guidelines recommend monitoring serum trough concentrations. Consider monitoring serum trough concentrations for other infections; itraconazole has a variable pharmacokinetic profile and high concentrations may increase the risk of adverse events.

How to administer Itraconazole (Sporanox)?

Oral:

Formulations are not interchangeable; generally, the oral solution is the preferred formulation because of improved absorption.
Administer capsule and tablet with a full meal.
The oral solution should be taken on an empty stomach; when treating oropharyngeal and esophageal candidiasis, the solution should be swished vigorously in the mouth (10 mL at a time), then swallowed.
Swallow capsule whole; do not crush, chew, or break.

Mechanism of action of Itraconazole (Sporanox):

It inhibits cytochrome P450 activity and decreases ergosterol synthesis (principal sterol found in fungal cell membranes).

Absorption

Capsule: 100mg Sporanox capsule (Sporanox), requires gastric acidity (absorption increases when taken with food).
Tolsura 65 mg capsule (Tolsura 65 mg capsule), has a higher absorption when taken empty stomach. However, Tolsura (2x65 mg capsule) when combined with food can result in exposures similar those experienced when Sporanox (2x100 mg capsule) is taken with food.
Oral solution: Absorption increased when empty stomach.
Tablet: Prefers gastric acidity. Absorption is increased when taken with food.

Distribution:

Plasma concentrations are lower than plasma concentrations because they are highly lipophilic.
Concentrations of the highest amount are found in adipose and skin/nails, omentum and endometrium, cervical mucus, vaginal mucus and cervical mucus.
The concentrations of aqueous fluids, such as CSF and urine, are negligible. They can be distributed into bronchial exudate or sputum.

Protein binding, plasma:

99.8%; metabolite hydroxy-itraconazole: 99.6%

Metabolism:

Extensively hepatic via CYP3A4 into >30 metabolites including hydroxy-itraconazole (major metabolite); appears to have in vitro antifungal activity.
The main metabolic pathway is oxidation; may undergo saturation metabolism with multiple dosing.

Bioavailability:

Variable, ~55% increases by 30% under fasted conditions (oral solution);
Note: The oral solution has a higher degree of bioavailability (149% ± 68%) relative to oral capsules; should not be interchanged

Half-life elimination:

Children (6 months to 12 years):
- Oral solution: ~36 hours;
- Metabolite hydroxy-itraconazole: ~18 hours
Adults: Oral:
- Single-dose: 16 to 28 hours,
- Multiple doses: 34 to 42 hours;
- Cirrhosis (single dose): 37 hours (range: 20 to 54 hours)

Time to peak, plasma:

Capsules/tablets: 2 to 5 hours;
Oral solution: 2.5 hours

Excretion:

Urine (<1% active drug, 35% as inactive metabolites);
feces (54%; ~3% to 18% as unchanged drug)

International Brand Names of Itraconazole:

Onmel
Sporanox
Sporanox Pulsepak
Tolsura
JAMP Itraconazole
MINT-Itraconazole
Sporanox
Arozole
Canadiol
Candistat
Canditral
Chme
Cladosol
Conazole
Funginox
Fungizol
Funit
Hantrazol
Hitrazole
Icomein
Icon
Iconal
Ikonaz
Inox
Isox
Itcozol
Itol
Itra
Itrabloxus
Itrac
Itracap
Itracon
Itrafung
Itragen
Itramed
Itranax
Itranol
Itranols
Itranox
Itrapex
Itrasix
Itrason
Itraspor
Itrazol
Itrazole
Itrizole
Itzol
Konitra
Lozanoc
Micogal
Micoral
Mycotrazol
Newtrazole
Norspor
Nufatrac
Omicral
Orugal
Orungal
Orzol
Quali-Itrazole
Rixtal
Sempera
Sinozol
Spazol
Sponex
Sporacid
Sporagal
Sporal
Sporanox
Sporanox IV
Sporavast
Spornar
Spyrocon
Trachon
Tracon
Tracor
Unitrac
Vanoran

Itraconazole Brand Names in Pakistan:

Itraconazole Capsule 100 Mg in Pakistan
Icon	Ferozsons Laboratoies Ltd.
It Cap	Bio Labs (Pvt) Ltd.
Itazol	Shaheen Agencies
Itra	English Pharmaceuticals Industries
Itracap	Genix Pharma (Pvt) Ltd
Itraderm	Derma Techno Pakistan
Itral	Lotus Pharmaceuticals (Pvt) Ltd
Itraneu	Neutro Pharma (Pvt) Ltd.
Itranex	Dermagen Pharma Pakistan (Pvt) Limited
Itraval	Valor Pharmaceuticals
Itrazole	Z-Jans Pharmaceutical (Pvt) Ltd.
Itrazox	Varioline International (Pvt) Ltd.
Itrdym	Evergreen Pharmaceuticals Pvt Limited
Itrofit	Bryon Pharmaceuticals (Pvt) Ltd.
Itrop	Pearl Pharmaceuticals
Itropan	Wisdom Therapeutics
Itrotek	Innvotek Pharmaceuticals
Oracone	Biorex Pharmaceuticals
Rolac	Sami Pharmaceuticals (Pvt) Ltd.
Soprazole	Schazoo Zaka
Sporanox	Janssen-Cilag
Sporocid	Tg Pharma
Sporokil	Mediceena Pharma (Pvt) Ltd.
Traconol	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Trucon	Goodman Laboratories
Vigilant	English Pharmaceuticals Industries

Comments

NO Comments Found

Ivermectin Tablets - Uses, Dose, Side effects
13-12-2021

Lindane - Uses, Dose, MOA, Brands, Side effects
13-12-2021

Luzu Cream (Luliconazole) - Uses, Dose, Side effects, MOA
13-12-2021

Mafenide (Sulfamylon) Cream, Solution - Uses, Side effects, Warnings
13-12-2021

Itraconazole (Sporanox) - Uses, Dose, Side effects, MOA, Brands

Itraconazole (Sporanox) Uses:

Aspergillosis (capsules):

Blastomycosis (capsules):

Histoplasmosis (capsules):

Onychomycosis:

Oropharyngeal/Esophageal candidiasis (oral solution):

Candidiasis, oral, and/or esophageal:

Chromomycosis:

Dermatomycoses:

Onychomycosis:

Paracoccidioidomycosis:

Sporotrichosis:

Off Label Use of Itraconazole in Adults:

Itraconazole (Sporanox) Dose in Adults:

Itraconazole (Sporanox) Dose as an alternative agent in the treatment of Invasive Aspergillosis, (salvage therapy):

Itraconazole (Sporanox) Dose in the treatment of Blastomycosis:

Itraconazole (Sporanox) Dose in the treatment of Candidiasis: Oral:

Esophageal:

Oropharyngeal:

Itraconazole (Sporanox) Dose in the treatment of Vulvovaginal (uncomplicated) in HIV-infected patients (alternative to preferred therapy) (off label):

Itraconazole (Sporanox) Dose in the treatment of Chromomycosis: Canadian labeling (not in US labeling):

Itraconazole (Sporanox) Dose in the treatment of Coccidioidomycosis, extrapulmonary (non-HIV infected) (off-label): Oral:

Soft tissue infection (not associated with bone infection):

Bone and/or joint infection:

Itraconazole (Sporanox) Dose in the treatment of Coccidioidal pneumonia (off-label): Oral:

Non-HIV infected (symptomatic, chronic cavitary):

HIV-infected patients (focal pneumonia):

Itraconazole (Sporanox) Dose in the treatment of Coccidioidal meningitis (off-label):

Non-HIV infected:

HIV-infected patients (HHS [OI adult 2017]) (alternative agent): Oral:

Chronic suppressive therapy:

Itraconazole (Sporanox) Dose as an alternative agent in the treatment of Cryptococcosis in HIV-infected patients (off-label use): Oral:

Histoplasmosis:

Itraconazole (Sporanox) Dose in the treatment of Meningitis:

Maintenance therapy (following 4 to 6 weeks of induction therapy with an appropriate agent):

Prophylaxis (off-label):

Itraconazole (Sporanox) Dose in the treatment of Microsporidiosis, disseminated (caused by Trachipleistophora or Anncaliia) in HIV infected patients (off-label):

Itraconazole (Sporanox) Dose in the treatment of Onychomycosis (fingernail involvement only):

Itraconazole (Sporanox Dose in the treatment of Onychomycosis (toenails due to Trichophyton rubrum or T. mentagrophytes):

Itraconazole (Sporanox Dose in the treatment of Onychomycosis (toenails with or without fingernail involvement):

Canadian labeling (not in US labeling):

Itraconazole (Sporanox) Dose in the treatment of Paracoccidioidomycosis:

Canadian labeling (not in US labeling):

Itraconazole (Sporanox) Dose in the treatment of Penicilliosis in HIV-infected patients:

Primary prophylaxis:

Treatment:

Chronic maintenance (secondary prophylaxis):

Itraconazole (Sporanox) Dose in the treatment of Pityriasis versicolor:

Canadian labeling (not in US labeling):

Itraconazole (Sporanox) Dose in the treatment of Sporotrichosis: Oral:

Cutaneous:

Lymphocutaneous:

Osteoarticular and pulmonary:

Itraconazole (Sporanox) Dose in the treatment of Tinea corporis or tinea cruris:

Canadian labeling (not in US labeling):

Itraconazole (Sporanox) Dose in the treatment of Tinea pedis:

Canadian labeling (not in US labeling):

Itraconazole (Sporanox) Dose in Children:

Itraconazole (Sporanox) General dosing, susceptible infection: Limited data available:

Infants, Children, and Adolescents:

Itraconazole (Sporanox) Dose in the treatment of Blastomycosis, non-CNS infections:

Infants, Children, and Adolescents:

Itraconazole (Sporanox) Dose in the treatment of Candidiasis (HIV-exposed/-positive patients):

Oropharyngeal, treatment:

Esophageal, treatment:

Vulvovaginal, uncomplicated:

Secondary prophylaxis:

Itraconazole (Sporanox) Dose in the treatment of Coccidioidomycosis:

Treatment:

Itraconazole (Sporanox) Dose in the treatment of Cryptococcal meningitis (HIV-exposed/-positive):

Consolidation treatment:

Secondary prophylaxis/Relapse prevention:

Itraconazole (Sporanox) Dose in the treatment of Histoplasmosis: Limited data available:

Treatment:

Prophylaxis:

Itraconazole (Sporanox) Dose in the treatment of Microsporidiosis, a disseminated disease caused by Trachipleistophora or Anncaliia, treatment (HIV-exposed/-positive):

Adolescents:

Itraconazole (Sporanox) Dose in the treatment of Penicilliosis (HIV-exposed/-positive):

Adolescents: