Micogal (Itraconazole)

Itraconazole is a systemic triazole antifungal used to treat infections caused by a variety of pathogenic fungi.

• Blastomycosis: eradicates systemic infection caused by Blastomyces dermatitidis.
• Histoplasmosis: treats disseminated disease due to Histoplasma capsulatum.
• Aspergillosis: manages invasive disease caused by Aspergillus species.
• Systemic Candidiasis: clears bloodstream and deep‑organ Candida infections.
• Dermatophytosis (off‑label oral use): resolves extensive skin fungal infections when topical therapy fails.
• Sporotrichosis: treats infection caused by Sporothrix schenckii.

• Itraconazole inhibits the fungal cytochrome P450 enzyme lanosterol 14α‑demethylase, blocking conversion of lanosterol to ergosterol. This disruption impairs fungal cell membrane synthesis, leading to increased membrane permeability and inhibition of fungal growth and replication.

Itraconazole may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Headache: transient cranial discomfort.
• Diarrhea: loose stools, usually self‑limiting.
• Abdominal pain: cramping or discomfort in the stomach area.
• Rash: mild skin redness or itching.
• Elevated liver enzymes: mild, reversible changes in hepatic labs.

Serious or Rare Side Effects

• Hepatotoxicity: significant liver injury requiring monitoring.
• Congestive heart failure: fluid retention and reduced cardiac function.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Visual disturbances: blurred vision or photophobia.
• Severe hypotension: marked drop in blood pressure after oral dosing.
• Anaphylaxis: rare, potentially life‑threatening allergic reaction.

Itraconazole requires careful monitoring and patient education before initiation.

• Monitor liver function: obtain baseline and periodic LFTs during therapy.
• Assess cardiac status: avoid in patients with uncontrolled heart failure.
• Review concomitant drugs: check for CYP3A4 substrates, inhibitors, or inducers.
• Counsel on food intake: advise taking with a full meal to enhance absorption.
• Pregnancy and lactation: use only if potential benefit outweighs risk; data are limited.
• Store below 25°C: keep in the original pack, protect from moisture.

Itraconazole interacts with several drug classes, necessitating vigilance.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): markedly reduce itraconazole exposure.
• Certain antiarrhythmics (e.g., quinidine, amiodarone): increase risk of cardiac toxicity.
• Statins metabolized by CYP3A4 (e.g., simvastatin, lovastatin): heightened risk of rhabdomyolysis.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): may raise itraconazole levels.
• Oral anticoagulants (e.g., warfarin): monitor INR for potential enhancement.
• Benzodiazepines (e.g., midazolam): may experience prolonged sedation.
• Proton pump inhibitors: can decrease itraconazole absorption; consider timing adjustments.