Itraconazole

MEDICATION TYPE

Antifungal

INDICATIONS

Treatment of ABPA in combination with steroids.

DRUG INTERACTIONS

Antacids
Reduced absorption of Itraconazole.

Calcium channel blockers
Possible negative inotropic effect could be potentiated.

Carbamazepine
Dose, if co-administered with Itraconazole, should be reduced if necessary.

Ciclosporin, Tacrolimus, Sirolimus
Increased plasma concentration. Dosage, if co-administered with Itraconazole, may need to be reduced, Avoid concomitant use with Sirolimus.

Cisapride
Qt interval prolongation. Avoid.

Digoxin
increased plasma digoxin concentration.

High dose inhaled steroids
there have been reports of adrenal suppression following the use of inhaled steroids and Itraconazole.

Macrolides – Clarithromycin and Erythromycin
May increase plasma concentration of Itraconazole.

Methylprednisolone
Increased plasma concentration of methylprednisolone.

Midazolam
dose, if co-administered with Itraconazole, should be reduced if necessary.

Phenytoin
Reduced plasma concentration of Itraconazole.

Proton Pump Inhibitors
Reduced absorption of iItraconazole.

Quinidine
Plasma levels of quinidine elevated:increased risk of ventricular Arrythmias.

Ranitidine and Cimetidine
Reduced absorption of Itraconazole.

Rifampicin
Reduced plasma concentration of Itraconazole.

Sildenafil, Tadalafil, Yardenafil
Increased plasma concentrations, dosage reduction may be required (sildenafil) or avoid concomitant use (Yardenafil).

Simvastatin, Atorvastatin
increased risk of myopathy; avoid concomitant use.

Tolterodine
Avoidance of Itraconazole advised by manufacturer of Tolterodone.

Warfarin
Effect of warfarin will be accentuated and the dose of warfarin should be reduced if necessary.

Ivacaftor
Increases the dose of Ivacaftor which must be reduced eg 1 tablet bd twice a week.

NOTES

Capsule needs acidic environment & food; solution on empty stomach. Many CYP3A4 interactions.