What is the recommended dosage of itraconazole for fungal infections?

Recommended Dosage of Itraconazole for Fungal Infections

The recommended dosage of itraconazole for fungal infections is 200 mg three times daily for the first 3 days (loading dose), followed by 200 mg twice daily as maintenance therapy, with treatment duration ranging from 6-12 months depending on infection severity. 1

Standard Dosing Regimens

Initial Loading Dose

• 200 mg three times daily for 3 days 2, 1

Maintenance Dose

• For mild to moderate disease: 200 mg once or twice daily for 6-12 months 2
• For moderately severe to severe disease: 200 mg twice daily for at least 12 months 2

Dosing Based on Infection Type

Pulmonary Fungal Infections

• Mild to moderate disease: 200 mg once or twice daily for 6-12 months 2
• Moderately severe to severe disease: Initial amphotericin B followed by itraconazole 200 mg twice daily for 6-12 months 2

Disseminated Extrapulmonary Infections

• Mild to moderate disease: 200 mg once or twice daily for 6-12 months 2
• Moderately severe to severe disease: 200 mg twice daily for at least 12 months 2
• Osteoarticular infections require at least 12 months of therapy 2

CNS Fungal Infections

• Following initial amphotericin B therapy: 200 mg 2-3 times daily for at least 12 months 2

Paracoccidioidomycosis

• 200 mg daily for 9-12 months 2
• For severe cases: Following amphotericin B induction, 200-400 mg daily 2

Administration Considerations

Formulation-Specific Instructions

• Capsule formulation: Take with food to maximize absorption 1
• Oral solution: Take on an empty stomach 1
• Avoid agents that decrease stomach acidity when taking capsules 1

Monitoring Requirements

• Serum levels should be measured after at least 2 weeks of therapy 2, 1
• Target trough concentration: >5 μg/mL for systemic infections 1
• Monitor for drug interactions and liver function periodically 1

Special Populations

Pediatric Patients

• 10 mg/kg per day (maximum 400 mg daily) 2, 1

Immunosuppressed Patients

• May require lifelong suppressive therapy at 200 mg daily 1
• Initial therapy with amphotericin B followed by itraconazole maintenance 2

Pregnancy

• Avoid use during pregnancy due to potential teratogenicity 1

Clinical Pearls and Pitfalls

Common Pitfalls

• Inadequate absorption: Failure to take capsules with food can result in subtherapeutic levels
• Insufficient duration of therapy: Premature discontinuation can lead to relapse
• Drug interactions: Itraconazole interacts with many medications through cytochrome P450 pathways

Important Considerations

• Higher doses (up to 600 mg/day) may be considered for severe infections but approach the upper limits of acceptable dosing for long-term treatment 3
• Reducing the dose prematurely may lead to progression of infection even if initial improvement is observed 3
• Potential side effects include hypokalemia, hypertension, and rarely adrenal insufficiency at higher doses 3

By following these dosing guidelines and monitoring recommendations, optimal therapeutic outcomes can be achieved while minimizing adverse effects in patients with fungal infections.