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Itraconazole - pedia Immunocompromised and non-immunocompromised patients: 200 mg PO q8hr for 3 days, then 200 mg PO q12hr for 6-12 months; initiate therapy with aproximately 2 weeks of amphotericin B if infection is moderately severe to severe Immunocompromised and non-immunocompromised patients: 200-400 mg/day PO; may be used in combination with corticosteroids Life-threatening infection: Administer a loading dose of 200 mg PO TID for first 3 days of therapy; continue treatment for at least 3 months and until clinical and laboratory evidence suggest that infection has resolved; current dose on candidiasis is for esophageal candidiasis Oral solution: 100-200 mg/day for at least 3 weeks; continued for 2 weeks after symptom resolution Refractory to fluconazole: 100 mg PO q12hr for 2-4 weeks Swish in mouth 10 m L at a time for several seconds, then swallow; take without food if possible Oropharyngeal candidiasis in patients unresponsive to fluconazole: 200 mg PO q Day for 1-2 weeks Orphan desnation for inhaled itraconazole using i SPERSE technology dry powder delivery platform to improve therapeutic delivery to the lungs by maximizing local concentrations and reducing systemic side effects Rash (9%) Vomiting (5%) Edema (4%) Headache (4%) Abnormal liver function test results (3%) Diarrhea (3%) Fever (3%) Hypertension (3%) Pruritus (3%) Fatue (2-3%) Abdominal pain (2%) Dizziness (2%) Hypertrlyceridemia (2%) Hypokalemia (2%) Albuminuria (1%) Anorexia (1%) Decreased libido (1%) Hepatitis (1%) Malaise (1%) Blood and Lymphatic System Disorders: Leukopenia, neutropenia, thrombocytopenia Immune System Disorders: Anaphylaxis; anaphylactic, anaphylactoid and allergic reactions; serum sickness; angioneurotic edema Nervous System Disorders: Peripheral neuropathy, paresthesia, hypoesthesia, tremor Eye Disorders: Visual disturbances, including vision blurred and diplopia Ear and Labyrinth Disorders: Transient or permanent hearing loss Cardiac Disorders: Congestive heart failure Respiratory, Thoracic and Mediastinal Disorders: Pulmonary edema, dyspnea Gastrointestinal Disorders: Pancreatitis, dysgeusia Hepatobiliary Disorders: Serious hepatotoxicity (including some cases of fatal acute liver failure), hepatitis Skin and Subcutaneous Tissue Disorders: Toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, erythema multiforme, exfoliative dermatitis, leukocytoclastic vasculitis, alopecia, photosensitivity, urticaria Musculoskeletal and Connective Tissue Disorders: Arthralgia Renal and Urinary Disorders: Urinary incontinence, pollakiuria Reproductive System and Breast Disorders: Erectile dysfunction General Disorders and Administration Site: Peripheral edema Onychomycosis treatment in pregnancy or contemplated pregnancy Hypersensitivity Contraindicated with certain CYP3A4 substrate drugs (see Black Box Warnings) Renal or hepatic impairment Treatment of onychomycosis in women who are pregnant or plan to become pregnant Ventricular dysfunction (eg, current or previous CHF), except for treatment of life-threatening or other serious infections Discontinue if liver disease develops, and perform liver function tests; readministration discouraged Prolongs QT interval; caution with concurrent QT-prolonging drugs or congenital long QT (see Black Box Warnings for drugs contraindicated for use with itraconazole) Not for the treatment of other indications in patients with evidence of ventricular dysfunction unless benefit clearly outwehs risks; practitioners should carefully review risks and benefits; risk factors include cardiac disease such as ischemic and valvular disease; snificant pulmonary disease such as chronic obstructive pulmonary disease; and renal failure and other edematous disorders; inform patients of sns and symptoms of CHF, and treat with caution; monitor for sns and symptoms of CHF during treatment; if sns or symptoms of CHF appear during therapy, discontinue treatment Oral capsule and oral solution are not bioequivalent; do not use interchangeably Parenteral form is incompatible with most aqueous solutions; use dedicated line, and do not mix with other drugs in any way If neuropathy occurs that may be attributable to itraconazole, discontinue treatment If cystic fibrosis patient does not respond to itraconazole, consider switching to alternative therapy; large differences in itraconazole pharmacokinetic parameters observed in cystic fibrosis patients Transient or permanent hearing loss reported in patients receiving treatment with itraconazole; several reports included concurrent administration of quinidine, which is contraindicated; the hearing loss usually resolves when treatment is stopped, but can persist in some patients May cause CNS depression, which may impair physical or mental abilities; caution when operating heavy machinery or performing tasks that require mental alertness Rare cases of serious hepatotoxicity reported in patients without preexisting liver disease or risk factors; use caution in patients with preexisting hepatic impairment; monitor liver function closely and adjust dose as necessary; not recommended for use in patients with elevated liver enzymes, active liver disease, or prior hepatotoxic reactions to other drugs unless the expected benefit exceeds the risk of hepatotoxicity Use with caution in patients with renal impairment; not studied Absorption of itraconazole capsules is reduced when gastric acidity reduced; administer capsules with acidic beverage in patients with reduced gastric acidity and do not administer concomitantly with acid suppressive therapy; monitor for response Only oral solution shown to be effective in oral/esophageal candidiasis; oral solution not recommended in patients at immediate risk for systemic candidiasis Itraconazole should not be used to treat voriconazole-refractory aspergillosis; both agents may share resistance mechanisms Precise dilution (3.33 mg/m L) is required to maintain stability and avoid precipitate formation Dilute with NS only; do not use dextrose or lactated Ringer solution Add 25 m L (1 ampule = 250 mg) to 50 m L NS Mix and withdraw 15 m L of solution before infusing Using flow-control device, infuse 60 m L of diluted solution (200 mg itraconazole; p H 4.8) over 60 minutes, using extension line and infusion set provided After administration, flush infusion set with 15-20 m L NS over 30 seconds to 15 minutes via 2-way stopcock; do not use bacteriostatic NS Discard entire infusion set The above information is provided for general informational and educational purposes only. Itraconazole code name R51211, invented in 1984, is a triazole antifungal agent prescribed to. Itraconazole has a broader spectrum of activity than fluconazole but not as broad as voriconazole or posaconazole. "Sporanox" itraconazole capsules should always be taken with food, as this improves absorption, however.

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