Infectious Disease Compendium

Itraconazole (Sporanox®)

Dosing

CrCl Formula

CrCl > 80: 200-400 mg iv/po q 24 h.

CrCl 80-50: 200-400 mg iv/po q 24 h.

CrCl 50-10:

CrCl < 10:

Hemodialysis:

Peritoneal dialysis:

Important side effects

Hypokalemia, congestive heart failure (iv), hepatotoxicity, n/v, diarrhea, neutropenia, rash, Stevens-Johnson syndrome.

Important drug interactions

Acid dependent absorption, drug levels will go to stink if you block stomach acid. acenocoumarol, alfentanil, alfuzosin, aluminum carbonate, basic, aluminum hydroxide, aluminum phosphate, amlodipine, amprenavir, anisindione, aprepitant, astemizole, atorvastatin, benzodiazepines, bexarotene, budesonide, buspirone, busulfan, calcium, carbamazepine, cerivastatin, cimetidine, cinacalcet, cisapride, clarithromycin, conjugated estrogens, corticosteroids, cyclosporine, darifenacin, dicumarol, didanosine, digoxin, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, disopyramide, docetaxel, dofetilide, eletriptan, ergot derivatives, erlotinib, erythromycin, esterified estrogens, estradiol, estriol, estrone, estropipate, eszopiclone, famotidine, felodipine, fentanyl, fosphenytoin, gefitinib, halofantrine, imatinib, indinavir, isoniazid, isradipine, lansoprazole, levomethadyl, lovastatin, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, nevirapine, nicardipine, nifedipine, nimodipine, nizatidine, omeprazole, pantoprazole, phenindione, phenobarbital, phenprocoumon, phenytoin, pimozide, quetiapine, quinidine, rabeprazole, ranitidine, ranitidine, repaglinide, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, roxatidine, saquinavir, sildenafil, simvastatin, sirolimus, sodium bicarbonate, tacrolimus, tadalafil, terfenadine, tolterodine, trazodone, trimetrexate, vardenafil, verapamil, vinca alkaloids, warfarin.

These drugs interact with damn near everything else so check with you pharmacist or this reference at CID.

May mess with the efficacy of rituximab (PubMed).

Rants and Screeds

Pearls

Coca-cola® is acidic and will increase serum levels of itraconazole. So coke does indeed add life.

Treatment of choice

Sporotrichosis.

Use for

Aspergillus (marginal at best, use voriconazole), Blastomyces dermatiditus, Candida albicans keratitis/oropharyngeal/esophageal/vaginal, chromoblastomycosis, cladophialophora bantiana, disseminated, Coccidioides immitis, Cryptococcus neoformans, dermatomycosis, fungal infections - prophylaxis, histoplasmosis, Leishmania, mycetoma, mycosis fungoides, Onychomycosis, Paracoccidiodes, Penicillium marneffei infection, phaeohyphomycosis, Pseudallescheria boydii, sporotrichosis, tinea unguium, yellow nail syndrome.

Don't use for

Class

Imidazole.