Itraconazole Dosing for Ringworm
For ringworm (tinea corporis/cruris), itraconazole should be administered at 200 mg once daily for 7 days. 1, 2
Dosing Regimens by Type of Ringworm
Tinea Corporis/Cruris (Body/Groin Ringworm)
- Standard regimen: 200 mg once daily for 7 days 1, 2
- Alternative regimen: 100 mg once daily for 15 days 3
- The 7-day regimen with 200 mg daily has shown faster onset of clinical and mycological cure (90% mycological cure rate) compared to longer treatment at lower doses 2
Tinea Pedis/Manus (Foot/Hand Ringworm)
- 200 mg once daily for 14 days (2 weeks) 1
- For palmoplantar infections: 100 mg once daily for 30 days 3
Tinea Capitis (Scalp Ringworm)
- Adults: 200 mg once daily for 2-4 weeks 1
- Children: 5 mg/kg/day for 4-6 weeks (maximum 400 mg daily) 1, 4
Administration Guidelines
Formulation Considerations
- Capsule formulation: Take with food to maximize absorption 1
- Oral solution: Take on an empty stomach for best absorption 1
- The oral solution has better bioavailability but may cause more gastrointestinal side effects 1
Special Populations
Children
- Dosage: 5 mg/kg/day (maximum 400 mg daily) 1, 4
- For tinea corporis/cruris: 5 mg/kg/day for 1 week 4
- For tinea pedis/manus: 5 mg/kg/day for 2 weeks 4
- Safety profile is good with minimal adverse effects (1.2% cutaneous eruption, 3.4% transient liver enzyme elevation) 4
Pregnant Women
- Itraconazole should be avoided during pregnancy due to potential teratogenicity 1
- Consider alternative antifungal agents or topical therapy 1
Monitoring
- Serum drug levels should be obtained after at least 2 weeks of therapy for systemic infections 1
- Target trough concentration: >5 μg/mL 1
- Monitor liver function tests periodically, especially in prolonged therapy 1
Clinical Pearls
- Therapeutic concentrations of itraconazole remain in the epidermis for up to four weeks after discontinuation of therapy 3
- This persistence in skin tissue allows for shorter treatment courses compared to other antifungals 3
- For extensive or recurrent infections, the higher dose shorter duration regimen (200 mg daily for 7 days) is preferred for better compliance and cost-effectiveness 2, 5
- Avoid agents that decrease stomach acidity when taking itraconazole capsules 1
The 7-day regimen with 200 mg daily offers the optimal balance between efficacy, convenience, and patient compliance for most cases of ringworm affecting the body and groin areas.