Can Itraconazole Cause Gastritis?
Yes, itraconazole can cause gastritis, which is explicitly listed as a known adverse event in current clinical practice guidelines. 1
Evidence from Clinical Guidelines
The most recent 2024 European Respiratory Journal guidelines from the ISHAM-ABPA Working Group clearly list gastritis among the adverse events associated with conventional itraconazole capsules, alongside headache, nausea, vomiting, liver toxicity, pedal edema, heart failure, and other side effects. 1 This represents the highest quality guideline evidence available on this question.
Gastrointestinal Adverse Effects Profile
Gastrointestinal disturbances are among the most common adverse reactions to itraconazole:
- Nausea occurs in approximately 11% of patients treated with itraconazole oral solution 2
- Diarrhea affects approximately 11% of patients 2
- Vomiting occurs in 7% of patients 2
- Abdominal pain is reported in 6% of patients 2
- Gastritis is specifically documented as an adverse event, though the exact incidence is not quantified in the FDA labeling 2
Formulation-Specific Considerations
The oral suspension formulation of itraconazole is associated with higher gastrointestinal adverse effects compared to capsules, which is particularly problematic in populations who already experience nausea, vomiting, or diarrhea. 1 This occurs despite the suspension having better absorption characteristics than capsules. 1
The conventional capsule formulation requires low gastric pH for dissolution and should be administered with meals to improve absorption, 1 while the super bioavailable capsule formulation should be given on an empty stomach. 1
Clinical Context and Monitoring
When prescribing itraconazole, clinicians should:
- Counsel patients about the risk of gastrointestinal adverse effects including gastritis, nausea, vomiting, and diarrhea 2
- Consider that mild gastrointestinal reactions are the most common adverse events, occurring in approximately 39% of patients on chronic therapy 3
- Recognize that gastrointestinal toxicity rarely leads to discontinuation of therapy 3
- Be aware that more serious gastrointestinal complications, such as pseudomembranous colitis, have been rarely reported with itraconazole use 4
Important Caveats
The gastrointestinal adverse effects of itraconazole are generally mild and self-limited, with the drug being well tolerated by the majority of patients. 3, 5 However, in patients with pre-existing gastrointestinal symptoms or conditions, the addition of itraconazole may exacerbate symptoms and complicate clinical management. 1