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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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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 for treating Invasive Aspergillosis, (salvage therapy):

Oral solution:
- 200 mg twice daily
- The length of therapy is at least 6 to 12 weeks, while it greatly depends on the severity and length of immunosuppression, the location of the disease, and signs 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:
  - Current clinical practise might not be reflected in the dosing in the prescribed information.
  - 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:
    - For up to 28 days, take 200 mg once daily.
  - HIV-infected patients (alternative agent):
    - 200 mg used orally once daily for seven to fourteen days.
- US labeling:
  - Current clinical practise might not be reflected in the dosing in the prescribed information.
  - 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 administered twice daily for 7–14 days
  - range of the maximum daily dose: 200 to 400 mg/day
- Adolescents: Oral solution:
  - During 7 to 14 days, take 200 mg once daily.
Esophageal, treatment:
- Infants and Children:
  - Fluconazole-refractory: Oral solution:
    - 2.5 mg/kg/dose twice day for at least 21 days, as well as for at least two weeks after symptoms have subsided.
- 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:
    - Maximum dose: 200 mg/dose; first dose: 2 to 5 mg/kg/dose given three times per day for three days.
    - Maximum dose: 200 mg/dose; maintenance: 2 to 5 mg/kg/dose twice day; treatment duration dictated 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):
  - Maximum dose: 200 mg/dose; initial load: 2.5 to 5 mg/kg/dose given three times daily for three days.
  - 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 dose: 2 to 5 mg/kg/dose, given three times a day for three days;
      - 200 mg maximum per 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):
        
        two doses of 2.5 to 5 mg/kg each day for six to twelve weeks;
        
        200 mg maximum per dosage.
- 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:
        
        two doses of 2 to 5 mg/kg per day for a full year;
        
        200 mg maximum per 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:
      - Maximum dose: 200 mg/dose; initial load: 2 to 5 mg/kg/dose, given three times daily for three days.
      - Maximum dose: 200 mg/dose; maintenance dose: 2 to 5 mg/kg/dose twice daily for 12 months.
    - 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: 5–10 mg/kg/dose once daily; 200 mg/dose is the maximum amount.
    - Adolescents:
      - Oral: 200 mg once daily.
  - Non-HIV-exposed/positive:
    - Infants, Children, and Adolescents:
      - Oral: 5 mg/kg/dose given once day; 200 mg/dose is the maximum.

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):
  - Continue for 2 to 4 weeks after all lesions have disappeared, taking 3 to 5 mg/kg/dose twice day.
  - 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:
  - For at least 12 months, provide 3 to 5 mg/kg/dose twice day; the maximum dose is 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.

Use with caution in patients with renal impairment; dosage adjustment may be required, according to the manufacturer's advice.

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
- Patients with moderate to severe renal or hepatic impairment should take fesoterodine, while those with severe renal impairment should take solifenacin (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	Amphotericin B's therapeutic efficacy may be reduced by antifungal agents (systemic azole derivatives).
Benperidol	The serum concentration of Benperidol may rise in response to CYP3A4 Inhibitors (Strong).
Benzhydrocodone	The serum levels of Benzhydrocodone may rise in response to CYP3A4 Inhibitors (Strong). In particular, there might be an increase in hydrocodone concentration.
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	The serum concentration of Brentuximab Vedotin may rise in response to P-glycoprotein/ABCB1 Inhibitors. More specifically, levels of the substance's active monomethyl auristatin E (MMAE) component might rise.
Brinzolamide	Brinzolamide's serum levels may rise in response to CYP3A4 Inhibitors (Strong).
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	The serum levels of busulfan may rise in response to antifungal agents (systemic azole derivatives). Separate monographs address isavuconazonium considerations.
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	Celiprolol's serum levels may rise in response to P-glycoprotein/ABCB1 inhibitors.
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)	Corticosteroids may be present in greater amounts in the serum while taking strong CYP3A4 inhibitors (Systemic). MethylPREDNISolone, PrednisoLONE (Systemic), and PredniSONE are exceptions.
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)	DexAMETHasone serum levels may rise in response to strong CYP3A4 inhibitors (Ophthalmic).
Dichlorphenamide	Dichlorphenamide's hypokalemic impact may be strengthened by antifungal agents (systemic azole derivatives).
Dienogest	The serum concentration of Dienogest may rise in response to CYP3A4 Inhibitors (Strong).
Doxercalciferol	The active metabolite(s) of doxercalciferol may have lower serum concentrations when taken with CYP3A4 Inhibitors (Strong).
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	Itraconazole's serum levels can drop. The serum concentration of istraconazole may rise when grapefruit juice is consumed.
HYDROcodone	CYP3A4 Inhibitors (Strong) may raise the level of HYDROcodone in the blood.
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	Losartan's metabolism may be slowed down by antifungal agents (systemic azole derivatives). In separate monographs, relevant Isavuconazonium concerns are covered.
Lumefantrine	Lumefantrine's serum levels may rise when taken with CYP3A4 Inhibitors (Strong).
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	Combination CYP3A4 and P-glycoprotein inhibitors may raise the level of Nintedanib in the blood.
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	The serum concentration of P-glycoprotein/ABCB1 Substrates may rise in response to P-glycoprotein/ABCB1 Inhibitors. P-glycoprotein inhibitors may also make it easier for p-glycoprotein substrates to reach particular cells, tissues, and organs where p-glycoprotein is abundant (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	Pravastatin's serum levels may rise in response to itraconazole.
Praziquantel	Praziquantel's serum levels may rise in response to CYP3A4 Inhibitors (Strong).
PrednisoLONE (Systemic)	PrednisoLONE serum levels may rise in response to strong CYP3A4 inhibitors (Systemic).
PredniSONE	PredniSONE's serum levels may rise in the presence of CYP3A4 Inhibitors (Strong).
Propafenone	Propafenone serum levels may rise after taking CYP3A4 Inhibitors (Strong). Management: Separate drug interaction monographs go into further detail about the medications indicated as exceptions to this book.
Prucalopride	Prucalopride's serum levels may rise in response to P-glycoprotein/ABCB1 inhibitors.
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 lower the serum level 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)	Tacrolimus metabolism may be decreased by systemic azole derivative antifungal agents (Topical). In separate monographs, relevant Isavuconazonium concerns are covered.
Tasimelteon	Tasimelteon's serum levels may rise in the presence of CYP3A4 Inhibitors (Strong).
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	The serum concentration of Vitamin K antagonists may rise after using itraconazole.
Zolpidem	traconazole may raise the level of zolpidem in the blood.
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 Afatinib's serum levels may rise in the presence of inhibitors. Management: If afatinib is poorly tolerated, reduce the dose by 10 mg. Some non-US labelling advises staying away from combinations wherever possible. If using, give the P-gp inhibitor either right away or right after the afatinib dose.
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	Itraconazole's serum levels can drop. The serum levels of itraconazole may rise when using antacids. Treatment: Give itraconazole under the brand name Sporanox at least two hours before or two hours after taking any antacids. Antacids may enhance the exposure to itraconazole of the Tolsura brand; you should think about lowering the dose.
Apixaban	CYP3A4 (Strong) and P-glycoprotein inhibitors may raise the level of apixaban in the blood. Treatment: According to US labelling, individuals who would ordinarily take 5 or 10 mg twice daily should reduce their apixaban dose by 50%, and those who would ordinarily receive 2.5 mg twice daily should stop taking it altogether. Any combination of uses is prohibited according to Canadian labelling.
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	The serum concentration of betrixaban may rise in response to P-glycoprotein/ABCB1 inhibitors. Treatment: If betrixaban is used with a P-glycoprotein inhibitor, reduce the adult dose to an initial single dose of 80 mg, followed by a dose of 40 mg once day.
Bilastine	The serum concentration of bilastine may rise in response to P-glycoprotein/ABCB1 inhibitors. Management: When possible, look into alternatives; bilastine should be avoided in patients using p-glycoprotein inhibitors who have moderate to severe renal insufficiency.
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	Calcium channel blockers' negative/toxic effects may be increased by antifungal agents (systemic azole derivatives). In particular, itraconazole may make verapamil or diltiazem's unfavourable inotropic effects worse. Calcium Channel Blockers' metabolism may be slowed down by antifungal agents (systemic azole derivatives). Fluconazole and isavuconazonium, which are covered in different monographs, probably have less powerful effects than those of other azoles. Treatment: Itraconazole should not be used concurrently with felodipine or nisoldipine. With any such combination, regular monitoring is advised; calcium channel blocker dose decreases might be necessary. Clevidipine is an exception.
Cardiac Glycosides	Cardiac Glycosides' serum levels may rise in response to itraconazole. Consider preemptive dose adjustments for cardiac glycosides while starting, changing, or stopping 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	Cobicistat's serum levels may rise when itraconazole is used. Itraconazole's serum levels may rise in response to cobicistat. Treatment: Patients receiving the combo drug elvitegravir/cobicistat/emtricitabine/tenofovir should not take more than 200 mg of itraconazole per day for adults. There are no dosage guidelines for other cobicistat-containing medicines.
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	The serum concentration of colchicine may rise in response to P-glycoprotein/ABCB1 inhibitors. It's possible that colchicine will distribute more widely throughout some tissues, like the brain. Treatment: Patients receiving a p-glycoprotein inhibitor and having compromised renal or hepatic function should not take colchicine. Colchicine dosage should be decreased in patients with normal renal and hepatic function as instructed. For information, see the entire monograph.
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)	Systemic azole derivative antifungal agents may slow down cycloSPORINE metabolism (Systemic). Considerations related to fluconazole and isavuconazonium are covered in different monographs.
CycloSPORINE (Systemic)	Strong CYP3A4 Inhibitors may raise CycloSPORINE levels in the blood (Systemic).
CYP3A4 Inhibitors (Strong)	May slow down CYP3A4 substrate metabolism (High risk with Inhibitors).
CYP3A4 Substrates (High risk with Inhibitors)	The metabolism of CYP3A4 Substrates may be reduced by strong CYP3A4 Inhibitors (High risk with Inhibitors). Alitretinoin (Systemic), Amlopidine, Benzhydrocodone, Buprenorphine, Gefitinib, Hydrocodone, Mirtazapine, Praziquantel, Telithromycin, and Vinorelbine are exceptions.
Dabigatran Etexilate	The serum concentrations of the active metabolite(s) of dabigatran etexilate may rise in response to P-glycoprotein/ABCB1 inhibitors. Reducing the dose of dabigatran may be necessary for treatment. According to US vs. Canadian labelling, a particular P-gp inhibitor, renal function, and a therapy indication for dabigatran, specific advice varies greatly. Refer to the dabigatran labelling or the complete monograph.
Daclatasvir	Daclatasvir's serum levels may rise in response to strong CYP3A4 inhibitors. Treatment: If daclatasvir is coupled with a potent CYP3A4 inhibitor, reduce the dose to 30 mg once day. When administered with darunavir/cobicistat, daclatasvir does not require a dose change.
Darunavir	Itraconazole serum levels can rise. Itraconazole may raise the serum Darunavir levels. Treatment: Patients on darunavir/ritonavir should not take more than 200 mg of the maximum adult daily dose of itraconazole.
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	The blood concentrations of the active metabolite(s) of Deflazacort may rise in response to CYP3A4 Inhibitors (Strong). When taking deflazacort with a strong or moderate CYP3A4 inhibitor, only take one-third of the prescribed dose.
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	Could reduce how well antifungal agents are absorbed (Azole Derivatives, Systemic). Didanosine capsules with an enteric coating shouldn't have any impact on 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	The concentration of Edoxaban in the serum may rise in response to P-glycoprotein/ABCB1 inhibitors. Management: For more, see the whole monograph. Patients taking edoxaban for venous thromboembolism in conjunction with specific P-gp inhibitors are advised to take it in lower doses. It is not advised to modify the dosage when using edoxaban for 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	Elvitegravir's serum concentration might be raised by itraconazole. Treatment: For patients using elvitegravir-containing medications, itraconazole dosage should be capped at 200 mg per day.
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	Eszopiclone's serum levels may rise in the presence of CYP3A4 Inhibitors (Strong). When used with potent CYP3A4 inhibitors, the dose of eszopiclone should be restricted to 2 mg per day. Eszopiclone effects and toxicities should also be closely monitored (eg, somnolence, drowsiness, CNS depression).
Etizolam	The serum levels of Etizolam may rise when using CYP3A4 Inhibitors (Strong). Management: If using this combination, think about utilising lower etizolam doses; there are no precise guidelines for dose reduction. Keep a watchful eye on the combination's clinical reaction.
Etravirine	Azole derivatives used systemically as antifungal agents may raise etravirine levels in the blood. In separate monographs, relevant Isavuconazonium concerns are covered. Etravirine may lower the level of antifungal agents in the serum (Azole Derivatives, Systemic). With itraconazole or ketoconazole, this could be anticipated. The serum concentration of antifungal agents may rise when taking etravirine (Azole Derivatives, Systemic). With the use of voriconazole, this would be expected. Management: Keep an eye out for etravirine's enhanced side effects and toxicity. Ketoconazole, itraconazole, or posaconazole may require antifungal dose adjustment, although there are no precise dosing recommendations available.
Fedratinib	Fedratinib's serum levels may rise when taken with CYP3A4 Inhibitors (Strong). Management: When feasible, take into account alternatives. Fedratinib dosage should be reduced if combined to 200 mg daily. Increase fedratinib dosage to 400 mg for the first two weeks after the inhibitor is withdrawn.
FentaNYL	The serum levels of FentaNYL may rise when using CYP3A4 Inhibitors (Strong). Management: After starting this combination, keep a watchful eye on the patients for a few days and alter the fentanyl dosage 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	Itraconazole serum levels can rise. Itraconazole serum concentrations may be reduced by histamine H2 receptor antagonists. Treatment: Give itraconazole under the brand name Sporanox at least two hours before or two hours after taking any histamine H2 receptor antagonists (H2RAs). H2RAs may enhance the exposure to itraconazole under the Tolsura brand; consider lowering the dose.
Iloperidone	The active metabolite(s) of iloperidone may be present in higher serum quantities while using CYP3A4 Inhibitors (Strong). In particular, levels of the metabolites P88 and P95 may rise. Iloperidone's serum levels may rise in response to strong CYP3A4 inhibitors.
Indinavir	The serum concentration of indinavir may rise when itraconazole is used. Itraconazole's serum levels may rise as a result of indinavir. When taking itraconazole, reduce the standard adult dose of indinavir to 600 mg every 8 hours. Keep an eye out for any increased systemic effects of itraconazole, especially harmful or toxic ones.
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	Itraconazole serum levels can rise. Treatment: Patients receiving lopinavir/ritonavir should not take more than 200 mg of the maximum adult daily dose of itraconazole.
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	The serum concentration of MiFEPRIStone may rise in response to CYP3A4 Inhibitors (Strong). Management: When paired with a potent CYP3A4 inhibitor, the maximum daily dose of mifepristone adult for treating hyperglycemia in Cushing's syndrome is 900 mg. Regardless of dose or indication, keep an eye out for increased mifepristone toxicity.
MiFEPRIStone	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: During and two weeks after mifepristone treatment, reduce doses of CYP3A4 substrates and keep an eye out for elevated amounts or toxicity. Fentanyl, pimozide, quinidine, sirolimus, and tacrolimus should all be avoided. Cyclosporine should also be avoided.
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	The serum levels of Panobinostat may rise in response to strong CYP3A4 inhibitors. Management: If a potent CYP3A4 inhibitor is required, reduce the dose of panobinostat to 10 mg.
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	The serum concentration of Rifamycin Derivatives may be raised by antifungal agents (systemic azole derivatives). Rifabutin appears to be the only drug impacted. Rifamycin derivatives may lower the level of antifungal agents in the serum (Azole Derivatives, Systemic). Management: Whenever you can, stay away from these pairings. Isavuconazonium and voriconazole are regarded as contraindicated.
Riociguat	Riociguat's serum levels may rise in response to itraconazole. Treatment: Take into account beginning with 0.5 mg of riociguat three times per day. Additionally, patients receiving this combination should be thoroughly watched for any indications or symptoms of hypotension.
Ritonavir	Itraconazole serum levels can rise. Treatment: In individuals taking ritonavir, the maximum daily adult dose of itraconazole should be no more than 200 mg.
Ruxolitinib	Ruxolitinib's serum levels may rise in response to CYP3A4 Inhibitors (Strong). Management: There are specific situations where this combination should be avoided. Monograph for more information.
Saquinavir	The serum levels of Saquinavir may rise when itraconazole is used. Itraconazole's serum levels can rise as a result of saquinavir. Treatment: Patients on saquinavir/ritonavir should not take more than 200 mg of the maximum adult daily dose of itraconazole.
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 elevate Sildenafil's serum levels. For the treatment of pulmonary arterial hypertension when sildenafil is administered, concurrent itraconazole is not advised. Itraconazole should be taken concurrently with a 25 mg starting dose of sildenafil if the drug is being used to treat erectile dysfunction.
Sirolimus	Itraconazole may raise the level of Sirolimus in the blood. Management: When starting or terminating any azole antifungal, sirolimus dose changes will probably be required. When commencing an azole antifungal, clinical data indicate sirolimus (adult) dose reductions of between 50 and 90 percent will be required, although specific recommendations are missing.
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	Tadalafil's serum levels may rise in response to itraconazole.
Talazoparib	Talazoparib's serum levels may rise in response to itraconazole. Management: Lower the dose of talazoparib to 0.75 mg once daily if concomitant use cannot be avoided. Increase the talazoparib dosage to the level used before itraconazole was started after a period of 3 to 5 times the drug's half-life.
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	Itraconazole serum levels can rise. Treatment: In patients receiving tipranavir, the maximum daily dose of itraconazole for adults should be 200 mg.
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	Venetoclax's serum levels may rise in response to CYP3A4 Inhibitors (Strong). Treatment: In patients with CLL/SLL, this combination is contraindicated during venetoclax commencement and ramp-up. Patients with AML must take lower doses of venetoclax during ramp-up, and lower dosages of the drug are needed for all patients throughout 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 intensify VinCRIStine's harmful or hazardous effects. VinCRIStine serum levels may rise in response to itraconazole.
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	The serum levels of ALPRAZolam may rise in response to itraconazole.
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 raise the level of disopyramide in the blood.
Dofetilide	Itraconazole may raise the level of dofetilide in the serum.
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	Itraconazole's serum levels can drop.
Eletriptan	Eletriptan's serum levels may rise in the presence of CYP3A4 Inhibitors (Strong).
Eplerenone	Eplerenone's serum levels may rise in response to itraconazole.
Ergoloid Mesylates	Ergoloid Mesylates' serum levels may rise in response to itraconazole.
Ergonovine	Ergonovine's serum levels may rise in response to itraconazole.
Ergotamine	Itraconazole may raise the level of ergotamine in the blood.
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	The serum concentration of Ivosidenib may increase when itraconazole is used. Itraconazole's serum levels may drop if you use ivosidenib.
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	Itraconazole's serum levels can drop.
Lumateperone	The serum levels of Lumateperone may rise in response to CYP3A4 Inhibitors (Strong).
Lurasidone	The serum levels of lurasidone may rise in response to strong CYP3A4 inhibitors.
Macitentan	The serum concentration of Macitentan may rise in response to strong CYP3A4 inhibitors.
Methadone	Itraconazole may raise the level of methadone in the blood.
Methylergonovine	Methylergonovine serum levels may rise in response to itraconazole.
Midazolam	Midazolam's serum levels may rise in response to itraconazole. Midazolam should not be taken orally. When administering intravenous midazolam to patients taking itraconazole, use extreme caution. Whenever possible, use lower initial dosages and keep a close eye out for any intensified or prolonged side effects.
Mizolastine	Mizolastine's serum levels may rise in response to antifungal agents (systemic azole derivatives).
Naloxegol	The serum levels of Naloxegol may rise in response to CYP3A4 Inhibitors (Strong).
Neratinib	Neratinib serum levels may rise when taking CYP3A4 Inhibitors (Strong).
Nevirapine	Itraconazole's serum levels can drop.
NiMODipine	The serum levels of NiMODipine may rise in response to CYP3A4 Inhibitors (Strong).
Nisoldipine	The serum levels of nisoldipine may rise in response to CYP3A4 Inhibitors (Strong).
Palbociclib	The serum levels of palbociclib may rise in response to CYP3A4 Inhibitors (Strong).
PAZOPanib	The serum concentration of PAZOPanib may rise in response to P-glycoprotein/ABCB1 inhibitors.
Pimozide	Pimozide's serum levels may rise in response to CYP3A4 Inhibitors (Strong).
QuiNIDine	Itraconazole may elevate QuiNIDine's serum levels.
Radotinib	CYP3A4 Inhibitors (Strong) may increase the serum concentration of Radotinib.
Ranolazine	Ranolazine's metabolism may be slowed down by systemic antifungal agents (azole derivatives). Considerations related to fluconazole and isavuconazonium are covered in different 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 (Systemic, Oral) Agents may lessen Saccharomyces boulardii's therapeutic impact.
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	Telithromycin serum levels may rise in response to itraconazole. The serum levels of itraconazole may rise in response to telithromycin.
Temsirolimus	The active metabolite(s) of temsirolimus' serum concentrations may rise in response to itraconazole.
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	The serum concentration of topotecan may rise in response to P-glycoprotein/ABCB1 inhibitors.
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)	The serum concentration of VinCRIStine may rise in response to P-glycoprotein/ABCB1 Inhibitors (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

Monitoring serum trough concentrations is advised for invasive aspergillosis (treatment or prolonged prophylaxis). Since itraconazole has a varied pharmacokinetic profile and high concentrations may raise the risk of adverse effects, it is advisable to monitor serum trough concentrations for other infections.

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

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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 for treating 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):