What is the use of nasal itraconazole (antifungal medication) for fungal infections?

From the Guidelines

Nasal itraconazole is not a recommended treatment for fungal infections of the nasal passages, and instead, oral antifungal medications like oral itraconazole (200-400 mg daily) or other treatments such as surgical debridement and topical antifungal solutions should be considered. For fungal sinus infections (fungal rhinosinusitis), the primary treatments typically include oral antifungal medications, surgical debridement, and sometimes topical antifungal solutions. If topical treatment is needed for nasal fungal infections, amphotericin B irrigation (100-250 μg/mL solution) is more commonly used, as supported by the guidelines for treatment of candidiasis 1. Itraconazole works by disrupting fungal cell membrane synthesis by inhibiting the cytochrome P450-dependent enzyme lanosterol 14-α-demethylase.

For invasive fungal sinusitis, systemic antifungals are essential, often with surgical debridement. Treatment duration typically ranges from 3-6 months depending on infection severity and patient response. Patients should be monitored for liver function abnormalities and drug interactions, as itraconazole is metabolized through the cytochrome P450 system, as noted in the clinical practice guidelines for the management of candidiasis: 2016 update by the infectious diseases society of america 1. Consultation with an otolaryngologist and infectious disease specialist is recommended for proper diagnosis and treatment planning of fungal sinus infections.

Some key points to consider when treating fungal sinus infections include:

• The use of oral antifungal medications, such as itraconazole, as a primary treatment option
• The importance of surgical debridement in the treatment of invasive fungal sinusitis
• The need for monitoring of liver function and potential drug interactions when using itraconazole
• The consideration of topical antifungal solutions, such as amphotericin B irrigation, for nasal fungal infections
• The recommendation for consultation with an otolaryngologist and infectious disease specialist for proper diagnosis and treatment planning.

It is also important to note that the guidelines for treatment of candidiasis, as outlined in the clinical practice guidelines for the management of candidiasis: 2016 update by the infectious diseases society of america 1, provide valuable information on the use of antifungal medications, including itraconazole, in the treatment of fungal infections. Additionally, the guidelines highlight the importance of considering the potential for drug interactions and liver function abnormalities when using these medications.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Nasal Itraconazole for Fungal Infections

• Nasal itraconazole is used for the treatment of fungal infections, including allergic fungal sinusitis (AFS) 2.
• Itraconazole is a triazole antifungal agent with broad-spectrum antifungal activity, making it a useful drug for the management of allergic and invasive mycoses worldwide 3.
• The use of itraconazole, along with endoscopic surgery, low-dose bursts of oral corticosteroids, and topical corticosteroids, is a safe and clinically effective regimen in the management of AFS 2.

Treatment of Fungal Sinusitis

• Itraconazole has been shown to be effective in the treatment of fungal sinusitis, including invasive fungal rhinosinusitis (IFRS) 4.
• Treatment of IFRS consists of reversing the underlying immunosuppression, antifungal therapy, and aggressive surgical debridement 4.
• Fungal infections of the nose and paranasal sinuses represent a spectrum of diseases ranging from colonization to invasive rhinosinusitis, and itraconazole is one of the treatment options available 5.

Efficacy and Safety of Itraconazole

• Itraconazole has a broad-spectrum of activity and is available in both an intravenous and oral form, making long-term use in chronic mycoses practical 3.
• The use of itraconazole has been shown to be safe and effective in the management of AFS, with no serious adverse effects attributed to itraconazole over 36,000 doses prescribed 2.
• However, pharmacokinetic variability and clinically important drug interactions make therapeutic drug monitoring (TDM) of itraconazole an important consideration 3.