What is the recommended dose of Itraconazole?

Recommended Dosing of Itraconazole

The recommended dose of itraconazole varies by indication, with 200 mg orally daily for cutaneous/lymphocutaneous infections and 200 mg orally twice daily for more severe systemic infections. 1

Dosing by Indication

Superficial Fungal Infections

• Cutaneous and lymphocutaneous sporotrichosis: 200 mg orally daily for 3-6 months (continue for 2-4 weeks after all lesions have resolved) 1
• Resistant tinea corporis: 200 mg twice daily for 2-4 weeks (continue until all lesions have resolved) 2
• Dermatophytosis (tinea corporis/cruris): 100 mg daily for 15 days 3, 4
• Tinea pedis/manuum: 100 mg daily for 30 days 3
• Oropharyngeal candidiasis: 200 mg (20 mL) oral solution daily for 1-2 weeks 5
• Fluconazole-resistant oropharyngeal candidiasis: 100 mg (10 mL) oral solution twice daily 5
• Esophageal candidiasis: 100 mg (10 mL) oral solution daily for minimum 3 weeks, continue for 2 weeks after symptom resolution 5

Systemic Fungal Infections

• Osteoarticular sporotrichosis: 200 mg orally twice daily for at least 12 months 1
• Pulmonary sporotrichosis (non-severe): 200 mg orally twice daily for at least 12 months 1
• Meningeal/disseminated sporotrichosis: Step-down therapy after amphotericin B, 200 mg twice daily to complete 12 months of therapy 1

Administration Considerations

Formulation-Specific Administration

• Capsules: Take with food to maximize absorption 1
• Oral solution: Take on an empty stomach for best absorption 1
• SUBA-itraconazole: Enhanced bioavailability formulation requiring lower doses 1

Important Administration Pitfalls

• Avoid antacids, H2 blockers, and proton pump inhibitors with capsule formulation as they decrease absorption 1
• For capsules: Take with a full meal or cola drink to increase gastric acidity 1
• For solution: Vigorously swish in mouth (if treating oral candidiasis) before swallowing 5

Therapeutic Drug Monitoring

Monitoring drug levels is strongly recommended due to high interindividual variability:

• When to check levels: After 2 weeks of therapy (steady state) 1
• Target trough concentrations:
  • For prophylaxis: 0.5-4 mg/L (itraconazole + hydroxy-itraconazole) 1
  • For treatment: 1-4 mg/L 1
  • Levels <0.5 mg/L associated with breakthrough infections 1
  • Levels >5 mg/L associated with increased toxicity 1

Monitoring Recommendations

• Hepatic function: Check liver enzymes before starting therapy and at 1,2, and 4 weeks, then every 3 months during therapy 1
• Drug levels: Check after 2 weeks of therapy 1
• For chronic therapy: Monitor drug levels at every outpatient visit 1

Special Populations

• Hepatic impairment: Use with caution, close monitoring required 5
• Renal impairment: Use with caution, limited data available 5
• Pregnant women: Avoid azoles; consider amphotericin B or local hyperthermia for cutaneous infections 1
• Children: 6-10 mg/kg to maximum of 400 mg daily for cutaneous/lymphocutaneous sporotrichosis 1

Common Pitfalls to Avoid

• Formulation confusion: Oral solution and capsules should not be used interchangeably 5
• Drug interactions: Significant potential for interactions through cytochrome P450 3A4 system 1, 6
• Inadequate monitoring: Failure to check drug levels may result in treatment failure 1
• Premature discontinuation: Continue treatment for specified duration after clinical resolution 1, 2

Itraconazole remains a valuable antifungal agent with excellent tissue penetration and continued activity after discontinuation, making it suitable for fixed treatment schedules in many fungal infections.