Recommended Dosage of Itraconazole for Fungal Infections
For fungal infections, itraconazole dosing should be tailored to the specific infection type, with 200 mg once or twice daily being the standard dose for most infections, with loading doses of 200 mg three times daily for the first 3 days in many cases.
Dosing by Infection Type
Oropharyngeal and Esophageal Candidiasis
- For oropharyngeal candidiasis: 200 mg (20 mL) oral solution daily for 1-2 weeks 1
- For fluconazole-refractory oropharyngeal candidiasis: 100 mg (10 mL) oral solution twice daily 1
- For esophageal candidiasis: 100 mg (10 mL) oral solution daily for minimum 3 weeks, continuing for 2 weeks after symptom resolution 1
- For fluconazole-refractory esophageal disease: itraconazole solution 200 mg once daily for up to 28 days 2
Blastomycosis
- Mild to moderate pulmonary disease: Itraconazole 200 mg once or twice daily for 6-12 months 2
- Moderately severe to severe pulmonary disease: Initial therapy with amphotericin B for 1-2 weeks, followed by itraconazole 200 mg three times daily for 3 days, then 200 mg twice daily for a total of 6-12 months 2
- Mild to moderate disseminated disease: Itraconazole 200 mg once or twice daily for 6-12 months 2
- Osteoarticular blastomycosis: Total treatment duration of at least 12 months 2
Superficial Fungal Infections
- Tinea corporis/tinea cruris: 100 mg daily for 15 days 3, 4
- Tinea pedis/tinea manuum: 100 mg daily for 30 days 3
- Onychomycosis: 200 mg daily for 3 months, or intermittent regimen of 400 mg daily for 1 week per month for 3-4 months 5
Special Considerations
Administration
- Itraconazole capsules should be taken with food to enhance absorption 2
- Itraconazole oral solution should be taken without food if possible 1
- Itraconazole capsules and oral solution should not be used interchangeably 1
Therapeutic Drug Monitoring
- Serum levels of itraconazole should be determined after at least 2 weeks of therapy to ensure adequate drug exposure 2
- Target trough levels above 5 μg/mL for severe systemic infections 6
Cautions
- Dose adjustments may be needed in patients with hepatic or renal impairment 1
- Significant drug-drug interactions occur due to cytochrome P450 inhibition 2
- High-dose therapy (600 mg/day) has been associated with adrenal insufficiency, hypokalemia, hypertension, and rhabdomyolysis 6
Duration of Therapy
- Superficial infections: 2-4 weeks for dermatophytosis; 3 months for onychomycosis 5, 3
- Systemic infections: 6-12 months for blastomycosis 2
- CNS infections: At least 12 months and until resolution of CSF abnormalities 2
- Immunosuppressed patients may require lifelong suppressive therapy if immunosuppression cannot be reversed 2