Itraconazole Dosing for Tinea Pedis
For tinea pedis, itraconazole should be dosed at 100 mg once daily for 30 days, or alternatively as pulse therapy at 200 mg twice daily for 1 week. 1
Standard Dosing Regimens
The evidence supports two effective approaches for treating tinea pedis with itraconazole:
Continuous Daily Therapy
- 100 mg once daily for 30 days is the established fixed-schedule regimen for tinea pedis 1
- This dosing achieves mycological cure rates of approximately 85% at follow-up visits 2-3 weeks post-therapy 2
- Itraconazole capsules should be taken with food for optimal absorption 3
Pulse Therapy (Alternative)
- 200 mg twice daily (400 mg total) for 1 week represents an effective pulse dosing option 4
- This regimen produces clinical response rates of 90% and mycological cure rates of 76% 4
- Pulse therapy offers the advantage of shorter treatment duration with comparable efficacy 4
Comparative Efficacy
Itraconazole demonstrates superior outcomes compared to griseofulvin:
- Mycological cure rates at follow-up are significantly higher with itraconazole (85% vs 48%, p<0.01) 2
- Clinical response occurs more rapidly with the 100 mg daily dose compared to lower doses 5
Alternative Oral Agent
Oral terbinafine 250 mg once daily for 1-2 weeks is the preferred alternative if itraconazole cannot be used, offering:
- Shorter treatment duration (1-2 weeks vs 30 days) 6, 7
- Mycological cure rates of 80-90% 7
- Similar efficacy to itraconazole with potentially lower relapse rates 6
Important Monitoring Considerations
- Monitor for drug interactions with warfarin, antihistamines, antipsychotics, digoxin, statins, and cyclosporine 3
- Avoid concomitant use with H2 blockers, phenytoin, and rifampicin which decrease itraconazole efficacy 3
- If treatment response is suboptimal after 2 weeks, check serum itraconazole levels 3
Common Pitfalls to Avoid
- Do not use shorter durations than 30 days for continuous therapy - tinea pedis requires longer treatment than tinea corporis/cruris (which only needs 15 days) 1
- Ensure proper food intake with capsules - absorption is significantly enhanced when taken with meals 3
- Consider examining for concomitant tinea infections - check for tinea capitis and examine family members for potential reinfection sources 6