Itraconazole

Itraconazole is an antifungal agent with a broad antifungal spectrum. Like fluconazole, it is a synthetic triazole Its mechanism of action is the same as that of the other triazoles. Itraconazole is the drug of choice for the treatment of blastomycosis, sporotrichosis, paracoccidioidomycosis, and histoplasmosis by Blastomyces and Sporothrix and for subcutaneous chromoblastomycosis. Itraconazole is an alternative agent in the treatment of infections caused by Aspergillus, Coccidioides, Cryptococcus, and Histoplasma. In esophageal candidiasis, the drug is active against some strains resistant to fluconazole. Itraconazole is also used extensively in the treatment of dermatophytoses, especially onychomycosis Itraconazole is well absorbed orally, but it requires acid for dissolution. Food increases the bioavailability of some preparations. The drug is not attained in the CSF.Like ketoconazole, itraconazole is extensively metabolized by the liver, but it does not inhibit androgen synthesis. Its major metabolite, hydroxyitraconazole, is biologically active, with a similar antifungal spectrum. Little of the parent drug appears in the urine, eliminating the need for dose reduction with renal failure.Adverse effects include nausea and vomiting, rash (especially in ic patients), hypokalemia, hypertension, edema, and headache. Itraconazole should be avoided in pregnancy. Itraconazole inhibits the metabolism of many drugs, including oral anticoagulants, statins, and quinidine. Inducers of the CYP450 system increase the metabolism of itraconazole. The capsules should not be taken by patients with evidence of ventricular dysfunction, such as congestive heart failure (CHF) or a history of CHF