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It is a synthetic triazole available for oral and intravenous administration. It is very active against most strains of histoplasma capsulatum, blastomycos is dermatitis, Cryptococcus neoformans, sporotrichum schenkii and dermophytes.

INDICATIONS: Indolent, non-meningeal infections due to B. dermatititis, H. Capsulatum, P. brasiliensis, C.Immitis, indolent invasive aspergillosis outside the central nervous system. Intravenous formulation is approved for initial two weeks therapy with blastomycosis, histoplasmosis and indolent aspergillosis. Other indications are distal sublingual onychomycosis, pseudalle-scheriasis.

CONTRAINDICATIONS: The intravenous formulation is contraindicated in patients with a creatinine clearance below 30 ml./min. hypersensitivity reactions, hepatic dysfunction and hypokalaemia are other contraindications for its use. Addison’s disease may be aggrevated with itraconazole.

SAFETY PROFILE: Development of hepatotoxicity or rash during treatment with itraconazole the drug continuation should be withdrawn the doses above 400 mg per day are not recommended for long-term use.

ADVERSE EFFECTS: Most common side effects are anorexia, nausea, vomiting and abdominal pain. Ceridemia, hypokalaemia, increased serum aminotransferase, skin rash. At higher doses other side effects may appear including adrenal insufficiency, lower limboedema, hypertension and rhabdomyolsis. Rare side effects include anaphylaxis. Severe rash, including stevens – Johnson syndrome.

DRUG INTERACTIONS: There is huge list of drugs interacting with itraconazole leading to either decrease therapeutic levels of itraconazole or increasing the serious toxicity of companion drugs as potentially fatal cardiac arrhythmias with cisapride, quinidine or astemizole, isoniazed, rifampicin, phenytoin, Phenobarbital, carbamazepine. H2-receptor blockers, antacids, proton pump inhibitiors, nevirapine may decrease the therapeutic blood levels of itraconazole reducing its efficacy; clarithromycin, indinavir, ritonavir may increase itraconazole concentration.itraconazole can increase the concentration of alprazolam, astemizole, buspirone, cisapride, cyclosporine, diazepam, digoxin, felodipine phenytoin, quinidine, ritonavir, sildenafil, sulfonylureas, warfarin etc.

DOSAGE: The usual dosage is 200 mg capsules once or twice daily with meals. 400-600 mg/d may be required in patients who are immunocompromised and severely diseased, in patients with life threatening infections a 600 mg loading dose is given for 3 or 4 days.