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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Side effects of itraconazole include nausea, abdominal pain, dyspepsia and headache. Do not use in patients with ventricular dysfunction or risk of heart failure. Check liver function if given for more than 1 month. As it is a potent inhibitor of cytochrome P450 enzymes it may elevate the blood levels of other drugs being taken concurrently such as statins, midazolam, ciclosporin, warfarin and oral hypoglycaemics (check BNF before prescribing). Fluconazole rarely causes hepatotoxicity.
Onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Dimitris Rigopoulos, Robert Baran
Itraconazole should be avoided during pregnancy and for 2 months before planning pregnancy (Class C) and also during lactation. It is metabolized in the liver by CYP450 3A4 enzyme system and therefore has a long list of potential drug interactions.
Diagnosis and Treatment of Fungal Keratitis
Published in Mahendra Rai, Marcelo Luís Occhiutto, Mycotic Keratitis, 2019
In addition to topical medication, oral administration of triazole drugs, like itraconazole, 0.2 g per day for 2 to 3 weeks, is effective for filamentous fungal infection, with few systemic side effects (Shi and Wang 2013). For severe FK with hypopyon or suspected endophthalmitis, intravenous infusion of fluconazole, 0.2 g daily and dose doubled for the first time, can be performed (Shi and Wang 2013). Systemic use of amphotericin B has been used less for its side effects; if needed, the general situation should be monitored. Tanure et al. (2000) reported that among 24 patients treated for FK with eye drops of natamycin and amphotericin B in combination with oral fluconazole, ketoconazole or itraconazole, 13 patients achieved visual acuity of 0.2 or more. In recent years, stromal injection of sensitive antifungal drugs has been detected to treat refractory FK. Prakash et al. (2008) injected 0.05–0.10 mL of voriconazole at a concentration of 500 mg/L into the corneal stroma of three eyes with an intractable deep fungal infection, resulting in ulcer healing without intraoperative or postoperative complications. Topical antifungal therapy combined with intrastromal injection of sensitive antifungal agents is potential for the treatment of resistant FK, but corneal stromal injection as an invasive procedure may cause corneal perforation, anterior chamber disappearance, and endophthalmitis, which requires the operator to be cautious for the aseptic procedure under an operating microscope.
Strategies to improve the diagnosis and clinical treatment of dermatophyte infections
Published in Expert Review of Anti-infective Therapy, 2023
Resistance to azoles has been reported in approximately 19% of dermatophytes, some azoles (voriconazole and posaconazole) that are quite effective in patients resistant to multiple drugs have been developed in recent years. However, resistance may develop against these new drugs in the future. In addition to developing new drugs, better bioavailable forms of old antifungal drugs are being produced, and a more bioavailable form of conventional itraconazole has been developed [58]. A better absorbed form (SUBA-itraconazole) of conventional itraconazole has been developed in fasted or fed healthy individuals. It has been shown that this new form of itraconazole is well tolerated in children and can be used for both the treatment and prevention of fungal infection [59]. Improvement was reported with the combination of ciclopiroxolamine and miconazole in a pediatric patient with extensive tinea corporis due to resistance to terbinafine and azoles [50]. In vitro studies on Trichophyton species have reported that efinaconazole, terbinafine, luliconazole, itraconazole, tavaborole, and itraconazole have synergistic effects [60].
Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients
Published in Expert Review of Anti-infective Therapy, 2022
Tracey C. Vlahovic, Aditya K. Gupta
Onychomycosis can be managed in several ways: pharmaceutically, mechanically (via nail debridement or laser therapy), and surgically. Compared to nail debridement and surgical avulsion of the nail, the pharmaceutical agents have robust data showing mycological cure. From a pharmaceutical perspective, oral or systemic antifungal options and topical options are available on the market. Systemic antifungals are currently assumed to be the most effective treatment for onychomycosis according to meta-analyses conducted [35]. Oral antifungal agents (e.g. terbinafine [an allylamine] and itraconazole [an imidazole]) are considered treatments of choice for onychomycosis because they can effectively reach the nail bed through systemic circulation [36]. However, these agents have limitations including: drug-drug interactions with agents that are metabolized by specific cytochrome P450 (CYP) enzymes (more often itraconazole), potential inhibition of certain CYP subtypes, and adverse effects such as congestive heart failure and hepatotoxicity, the latter of which requires liver functioning tests completed prior to initiation of therapy [29,30,36]. Itraconazole has boxed warnings of rare cases of serious hepatotoxicity with treatment, including liver failure and death. Even patients with no preexisting liver disease or serious underlying medical condition are at risk for hepatotoxicity as well as congestive heart failure [30]. Fosravuconazole (BFE1224) is an oral triazole antifungal agent approved for the treatment of onychomycosis in Japan [37], though it is not approved in the US.
Pharmacotherapeutic management of bronchial infections in adults: non-cystic fibrosis bronchiectasis and chronic obstructive pulmonary disease
Published in Expert Opinion on Pharmacotherapy, 2020
Marta Di Pasquale, Stefano Aliberti, Marco Mantero, Andrea Gramegna, Francesco Blasi
The triazoles are available in oral and intravenous formulations. Common side-effects of itraconazole therapy are gastrointestinal symptoms, hypokalaemia and a biochemical hepatitis. Voriconazole therapy is commonly associated with the development of a biochemical hepatitis, visual disturbances, a photosensitive rash with an increased risk of pre-malignant lesions and skin malignancies, and central nervous system symptoms including confusion, hallucinations, and hypokalaemia. The common side-effects of posaconazole therapy include gastrointestinal side-effects, electrolyte disturbances, and fatigue. Itraconazole, voriconazole and posaconazole can all cause a QT interval prolongation and have been associated with the development of a peripheral neuropathy. Isavuconazole has a long half-life, and a similar side-effect profile to the other triazoles but fewer visual side-effects and less photosensitivity than voriconazole [75]. All triazoles have important interactions with cytochrome P450 (CYP) enzymes with important drug–drug interactions. Therapeutic monitoring of triazole therapy is recommended both to reduce the risk of toxicity and prevent subtherapeutic levels, which could increase the risk of developing drug resistance.