Indications: oropharyngeal candidiasis, Vulvovaginal candidiasis, Recurrent Vulvovaginal Candidiasis.

Pityriasis versicolor. Tinea corporis and tinea cruris. Tinea pedis and tinea manuum. Onychomycosis.

Aspergillosis. Histoplasmosis. Systemic candidiasis and cryptococcosis including cryptococcal meningitis where other antifungal drugs inappropriate or ineffective. cryptococcal meningitis, Maintenance in HIV-infected patients to prevent relapse of underlying fungal infection and Prophylaxis in neutropenia when standard therapy inappropriate. Prophylaxis in patients with haematological malignancy or undergoing bone-marrow transplant. Systemic aspergillosis. Candidiasis and cryptococcosis including cryptococcal meningitis where other antifungal drugs inappropriate or ineffective.

Histoplasmosis.

Cautions: Absorption reduced in HIV-infection and neutropenia (monitor plasma- itraconazole concentration and increase dose if necessary); susceptibility to congestive heart failure.

Contra-indications: Acute porphyria

Hepatotoxicity Potentially life-threatening hepatotoxicity reported very rarely—discontinue if signs of hepatitis develop. Avoid or use with caution if history of hepatotoxicity with other drugs or in active liver disease. Monitor liver function if treatment continues for longer than one month, if receiving other hepatotoxic drugs, if history of hepatotoxicity with other drugs, or in hepatic impairment.

Hepatic impairment: use only if potential benefit outweighs risk of hepatotoxicity (dose reduction may be necessary)

Renal impairment: risk of congestive heart failure; bioavailability of oral formulations possibly reduced; use intravenous infusion with caution if eGFR 30–80 ml/minute/1.73 m2; avoid intravenous infusion if eGFR less than 30 ml/minute/1.73m2

Pregnancy: manufacturer advises use only in life- threatening situations (toxicity at high doses in animal studies); ensure effective contraception during treatment and until the next menstrual period following end of treatment

Breast-feeding: small amounts present in milk—may accumulate; manufacturer advises avoid

Side Effects: Nausea, vomiting, taste disturbances, abdominal pain, diarrhoea, hepatitis (see Hepatotoxicity above), dyspnea, headache, hypokalemia, rash. less commonly dyspepsia, flatulence, constipation, oedema, dizziness, peripheral neuropathy (discontinue treatment), menstrual disorder, myalgia; rarely pancreatitis, heart failure (see Cautions above), hypertriglyceridemia, erectile dysfunction, urinary frequency, leucopenia, visual disturbances, tinnitus, deafness, alopecia, photosensitivity, toxic epidermal necrolysis, Stevens- Johnson syndrome; also reported, blood pressure changes, confusion, drowsiness, tremor, thrombocytopenia, renal impairment, arthralgia. With intravenous injection hyperglycemia.

Dose: By mouth: oropharyngeal candidiasis.

Vulvovaginal candidiasis: 200 mg twice daily for 1 day Pityriasis versicolor, 200 mg once daily for 7 days Tinea corporis and tinea cruris, either 100 mg once daily for 15 days or 200 mg once daily for 7 days Tinea pedis and tinea manuum, either 100 mg once daily for 30 days or 200 mg twice daily for 7 days Onychomycosis, either 200 mg once daily for 3 months or course (‘pulse’) of 200 mg twice daily for 7 days, subsequent courses repeated after 21-day interval; fingernails 2 courses, toenails 3 courses Aspergillosis, 200 mg twice daily Histoplasmosis, 200 mg 3 times daily for 3 days, and then 200 mg once or twice daily Systemic candidiasis and cryptococcosis including cryptococcal meningitis where other antifungal drugs inappropriate or ineffective, 200 mg once daily (candidiasis 100–200 mg once daily) increased in invasive or disseminated disease and in cryptococcal meningitis to 200 mg twice daily Maintenance in HIV-infected patients to prevent relapse of underlying fungal infection and prophylaxis in neutropenia when standard therapy inappropriate, 200 mg once daily, increased to 200 mg twice daily if low plasma-itraconazole concentration.

Prophylaxis in patients with haematological malignancy or undergoing bone- marrow transplant, oral liquid below By intravenous infusion, systemic aspergillosis, candidiasis and cryptococcosis including cryptococcal meningitis where other antifungal drugs inappropriate or ineffective, histoplasmosis, 200 mg every 12 hours for 2 days, then 200 mg once daily for max. 12 days.