Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-29T11:57:55.596Z Has data issue: false hasContentIssue false

Itraconazole: A New Triazole Antifungal Agent

Published online by Cambridge University Press:  02 January 2015

Abstract

The azole antifungal agents represent a major advance in the management of superficial and systemic fungal infections. Itraconazole appears to have a broad spectrum of in vitro activity and is the first azole antifungal agent to have activity against Aspergillus species. Itraconazole acts primarily by impairing the synthesis of ergosterol, resulting in a defective fungal cell membrane with altered permeability and function. It is effective for a wide variety of mycotic infections and some fungal meningeal infections. Most adverse effects have been relatively minor and do not lead to discontinuation of therapy.

Type
Clinical Pharmacology of Antibiotics
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cleary, JD, Taylor, JW, Chapman, SW. Itraconazole in antifungal therapy. Ann Pharmacother 1992;26:502509.Google Scholar
2.Bodey, GI? Azole antifungal agents. Clin Infect Dis 1992;14(suppl 1):S161S169.Google Scholar
3.Yoshida, Y, Aoyama, Y. Interaction of azole antifungal agents with cytochrome F450 purified from Saccharomyces cerevisiae microsomes. Biochem Phamnacol 1987;36:229235.Google Scholar
4.Borgers, M. Mechanism of action of antifungal drugs, with special reference to the imidazole derivative. Rev Infect Dis 1980;2:520534.Google Scholar
5.Sud, IJ, Feingold, DS. Mechanisms of action of the antimycotic imidazoles. J Invest Dermatol 1981;76:438441.Google Scholar
6.Sud, IJ, Feingold, DS. Heterogenicity of action mechanisms among antimycotic imidazoles. Antimicrob Agents Chemother 1981;20:7174.Google Scholar
7.Odds, FC, Cockayne, A, Hayward, J, et al.Effects of imidazole and triazole-derivative antifungal compounds on the growth and morphological development of Candida albicans hyphae. J Gen Microbial 1985;131:25812589.Google Scholar
8.Borgers, M, Van de Ven, M. Degenerative changes in fungi after itraconazole treatment. Rev Infect Dis 1987;9(suppl 1):S33S42.Google Scholar
9.Del Palacio-Hemanz, A, Frias-Iniesta, J, Gonzalez-Valle, O, et al.Itraconazole therapy in pityriasis versicolor. Br J Derm 1986;115:217225.Google Scholar
10.Graybill, JR. Future directions of antifungal chemotherapy. Clin Infect Dis 1992:14:(suppl 1):S170S181.Google Scholar
11.Sheehan, DJ, Espinel-Ingroff, A, Moore, LS, Webb, CD. Antifungal susceptibility testing of yeasts: a brief overview. Clin Infect Dis 1993;17(suppl 2):S494S500.Google Scholar
12.Van Cutsem, J, Van Gerven, F, Janssen, PAJ. Activity of orally, topically, and parenterally administered itraconazole in the treatment of superficial and deep mycoses: animal models. Rev Infect Dis 1987:9(suppl 1):S15S32.Google Scholar
13.Espinel-Ingroff, A, Shaddmy, S, Gebhart, RJ. In vitro studies with R51,211 (itraconazole). Antimicrob Agents Chemother 1984;26:59.Google Scholar
14.Graybill, JR, Stevens, DA, Galgiani, JN, Dismukes, WE, Cloud, GA. Itraconazole treatment of coccidioidomycosis. Am J Med 1990;89:282290.Google Scholar
15.DuPont, B, Drouhet, E. Early experience with itraconazole in vitro and in patients: pharmacokinetic studies and clinical results. Rev Infect Dis 1987;9(supp1 1):S71S76.Google Scholar
16.Denning, DW, Tucker, RM, Hanson, LH, Stevens, DATreatment of invasive aspergillosis with itraconazole. Am J Med 1989;86:791800.Google Scholar
17.Heykants, J, Van Peer, A, Lavrijsen, K, Meuldermans, W, Woestenborghs, R, Cauwenbergh, G. Pharmacokinetics of oral antifungals and their clinical implications. Br J Clin Pract 1990;44(suppl 9):5056.Google Scholar
18.Barone, JA, Koh, JG, Bierman, RH, et al., Food interaction and steady-state pharmacokinetics of itraconazole capsules in healthy male volunteers. Antimicrob Agents Chemother 1993;37:778784.Google Scholar
19.Van Perr, A, Woestenborghs, R, Heykants, J, Gasparini, R, Cauwenbergh, G. The effects of food and dose on the oral systemic availability of itraconazole in healthy subjects. Eur J Clin Pharmacol 1989;36:423426.Google Scholar
20.Wishart, JM. The influence of food on the pharmacokinetics of itraconazole in patients with superficial fungal infection. J Am Acad Dermatol 1987;17:220223.Google Scholar
21.Smith, D, Van de Velde, V, Woestenborghs, R, Gazzard, BG. The nharmacokinetics of oral itraconazole in AIDS patients. J Pharm Phamtacol 1992;44:618619.Google Scholar
22.Lake-Bakaar, G, Tom, W, Lake-Bakaar, D, et al.Gastropathy and ketoconazole malabsorption in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988;109:471473.Google Scholar
23.Tricot, G, Joosten, E, Boogaerts, MA, Vande Pitte, J, Cauwenbergh, G. Ketoconazole vs itraconazole for antifungal prophylaxis in patients with severe granulocytopenia: preliminary results of two nonrandomized studies. Rev Infect Dis 1987;9(suppl 1):S94S99.Google Scholar
24.Hardin, TC, Graybill, JR, Fetchick, R, Woestenborghs, R, Rinaldi, MG, Kuhn, JG. Pharmacokinetics of itraconazole following oral administration to normal volunteers. Antimicrob Agents Chemother 1988;32:13101313.Google Scholar
25.Larosa, E, Cauwenbergh, G, Cilli, P, Woestenborghs, R, Heykants, J. Itraconazole pharmacokinetics in the female genital tract: plasma and tissue levels in patients undergoing hysterectomy after a single dose of 200 mg itraconazole. Eur J Obstet Gynecol Reprod Biol 1986;23:8589.Google Scholar
26.Cauwenbergh, G, Degreef, H, Heykants, J, Woestenborghs, R, Van Rooy, P, Haeverans, K. Pharmacokinetic profile of orally administered itraconazole in human skin. J Am Acad Dermatol 1988;18:263268.Google Scholar
27.Willemsen, M, De Doncker, P, Willems, J. Posttreatment itraconazole levels in the nail. J Am Acad Dermatol 1992;26:731735.Google Scholar
28.Van Cauteren, H, Heykants, J, De Coster, R, Cauwenbergh, G. Itraconazole: pharmacologic studies in animals and humans. Rev Infect Dis 1987;9(suppl 1):S43S46.Google Scholar
29.Heykants, J, Van Peer, A, Van de Velde, P, et al.The clinical pharmacokinetics of itraconazole: an overview. Mycoses 1989;32(suppl 1):6787.Google Scholar
30.Boelaert, J, Schurgers, M, Matthys, E, et al.Itraconazole pharmacokinetics in patients with renal dysfunction. Antimicrob Agents Chemother 1988;32:15951597.Google Scholar
31.Degreef, H, Marien, K, De Veylder, H, Duprez, K, Borghys, A, Verhoeve, L. Itraconazole in the treatment of dermatophytoses: a comparison of two daily dosages. Rev Infect Dis 1987;9(suppl 1):S104S108.Google Scholar
32.Saul, A, Bonifaz, A, Arias, I. Itraconazole in the treatment of superficial mycoses: an open trial of 40 cases. Rev Infect Dis 1987;9(suppl 1):S100S103.Google Scholar
33.Nuijten, STM, Schurgers, JL. Itraconazole in the treatment of tinea corporis: a pilot study. Rev Infect Dis 1987;9(suppl 1):s119s120.Google Scholar
34.Panconesi, E, Difonzo, E. Treatment of dermatophytoses and pityriasis versicolor with itraconazole. Rev Infect Dis 1987;9(suppl 1):S109S113.Google Scholar
35.Akantara, R, Garibay, JM. Itraconazole therapy in dermatomycosis and vaginal canhidiasis: efficacy and adverse effects profile in a large multicenter study. Adv Ther 1988;5:326333.Google Scholar
36.Bourloid, A, Lachapelle, JM, Aussems, J, et al.Double-blind comparison of itraconazole with griseofulvin in the treatment of tinea corporis and tinea cruis. Int J Dermatol 1989;28:410412.Google Scholar
37.Panagiotidou, D, Kousidou, T, Chaidemenos, G. A comparison of itraconazole and griseofulvin in the treatment of tinea corporis and tinea cruris: a double-blind study. J Intern Med Res 1992;20:392400.Google Scholar
38.Lachapelle, JM, De Doncker, P, Tennstedt, D, Cauwenbergh, G, Janssen, PA. Itraconazole compared with griseofulvin in the treatment of tinea corporis/cruris and tinea pedis/manus: an interpretation of all completed double-blind studies with respect to the pharmacokinetic profile. Dematology 1992;184:4550.Google Scholar
39.Roseeuw, D, Willemsen, M, Kint, RT, Peremans, W, Mertens, RLJ, Van Cutsem, J. Itraconazole in the treatment of superficial mycoses-a double-blind study vs. placebo. Clin Exp Dermatol 1990;15:101104.Google Scholar
40.Faergemann, J. Treatment of pityriasis versicolor with itraconazole: a double-blind placebo controlled study. Mycoses 1988;31:377379.Google Scholar
41.Galimberti, RL, Villalba, I, Galarza, S, Raimondi, A, Flores, V. Itraconazole in pityriasis versicolor: ultrastructural changes in Malassezia furfur produced during treatment. Rev Infect Dis 1987;9(suppl 1):S134S138.Google Scholar
42.Morales-Doria, M. Pityriasis versicolor: efficacy of two five-day regimens of itraconazole. Rev Infect Dis 1987;9(suppl 1):S131S133.Google Scholar
43.Delescluse, J. Itraconazole in tinea versicolor: a review. J Am Acad Dermatol 1990;23:551554.Google Scholar
44.Del Palacio-Hemanz, A, Delnado Vicente, S. Menendez Ramos, F, Rodriguez-Noriega Belaugtegui, A. Randdmized comparative clinical trial of itraconazole and selenium sulfide shampoo for the treatment of pityriasis versicolor. Rev Infect Dis 1987;9(suppl 1): S121S127.Google Scholar
45.Grant, SM. Clissold SE Itraconazole: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in superficial and systemic mycoses. Drugs 1989;37:310344.Google Scholar
46.Cauwenbergh, G, DeDoncker, P, Stoops, K, De Dier, DM, Goyvaerts, H, Schuermans, V. Itraconazole in the treatment of human mycoses: review of three years of clinical experience. Rev Infect Dis 1987;9(suppl 1):S146S152.Google Scholar
47.Silva-Cruz, A, Andrade, L, Sobral, L, Francisca, A. Itraconazole versus placebo in the management of vaginal candidiasis. Int J Gynaecol Obstet 1991;36:229232.Google Scholar
48.Sanz Sanz, F, Del Palacio-Hernanz, A. Randomized comparative trial of three regimens of itraconazole for treatment of vaginal mycoses. Rev Infect Dis 1987;9(suppl 1):S139S142.Google Scholar
49.Wesel, S. Itracdnazole: a single-day oral treatment for acute vulvovaginal candidosis. Br J Clin Pract Symp Suppl 1990;71:7780.Google Scholar
50.Stein, GE, Mummaw, N. Placebo-controlled trial of itraconazole for treatment of acute vaginal candidiasis. Antimicrob Agents Chemother 1993;37:8992.Google Scholar
51.Tobin, JM, Loo, P, Granger, SE. Treatment of vaginal candidosis: a comparative study of the efficacy and acceptability of itraconazole and clotrimazole. Genitourin Med 1992;68:3638.Google Scholar
52.Merkus, TM, Van Heusden, AM. Chronic vulvovaainal candidosis: the role of oral treatment. Br J Clin Practr Symp Suppl 1990;71:8184.Google Scholar
53.Fong, IW. The value of chronic suppressive therapy with itraconazole versus clotrimazole in women with recurrent vaginal candidiasis. Genitourin Med 1992;68:374377.Google Scholar
54.Blatchford, NR. Treatment of oral candidosis with itraconazole: a review. J Am Acad Dermatol 1990;23:565567.Google Scholar
55.Smith, DE, Midgley, J, Allan, M, Connolly, GM, Gazzard, BG. Itraconazole versus ketaconazole in the treatment of oral and oesophageal candidosis in patients infected with HIV. AIDS 1991;5:13671371.Google Scholar
56.Hay, RJ, Clayton, YM, Moore, MK, Midgely, G. An evaluation of itraconazole in the management of onychomycosis. Br J Dermatol 1988;119:359366.Google Scholar
57.Piepponen, T, Blomqvist, K, Brandt, H, et al.Efficacy and safety of itraconazole in the long-term treatment of onychomycosis. J Antimicrob Chemother 1992;29:195205.Google Scholar
58.Arenas, R, Fernandez, G, Dominguez, L. Onychomycosis treated with itraconazole or griseofulvin alone with and without a topical antimycotic or keratolytic agent. Int J Dermatol 1991;30:586589.Google Scholar
59.Viviani, MA, Tortorano, AM, Langer, M, et al.Experience with itraconazole in ctyptococcosis and aspergillosis. J Infect 1989;18:151165.Google Scholar
60.Viviani, MA, Tortorano, AM, Pagano, A, et al.European experience with itraconazole in systemic mycoses. J Am Acad Dermatol 1990;23:587593.Google Scholar
61.Denning, DW, Tucker, RM, Hanson, LH, Hamilton, JR, Stevens, DA. Itraconazole therapy for cryptococcal meningitis and cryntococcosis. Arch Intern Med 1989;149:23012308.Google Scholar
62.Denning, DW, Tucker, RM, Hanson, LH, Stevens, DA. Itraconazole in opportunistic mycoses: cryptococcosis and aspergillosis. J Am Acad Dermatol 1990;23:602607.Google Scholar
63.de Gans, J, Portegies, P, Tiessens, G, et al.Itraconazole compared with amphotericin B plus flucytosine in AIDS patients with cryptococcal meningitis. AIDS 1992;6:185190.Google Scholar
64.Powderly, WG, Saag, MS, Cloud, GA, et al.A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:793798.Google Scholar
65.DuPont, B. Itraconazole therapy in aspergillosis: study in 49 patients. J Am Acad Dermatol 1990;23:607614.Google Scholar
66.Phillips, P, Fetchick, R, Weisman, I, Foshee, S, Graybill, JRTolerance to and efficacy of itraconazole in treatment of systemic mycoses: preliminary results. Rev Infect Dis 1987;9(suppl 1):S87S93.Google Scholar
67.Thomas, PA, Abraham, DJ, Kalavathy, CM, Rajasekaran, J. Oral itraconazole therapy for mycotic keratitis. Mycoses 1988;31:271279.Google Scholar
68.Negroni, R, Palmieri, O, Koren, F, Tiraboschi, IN, Galimberti, RL. Oral treatment of paracoccidioidomycosis and histoplasmosis with itraconazole in humans. Rev Infect Dis 1987;9(suppl 1):S47s50.Google Scholar
69.Negroni, R, Robles, AM, Arechavala, A, Taborda, A. Itraconazole in human histonlasmosis. Mycoses 1989;32:123130.Google Scholar
70.Dismukes, WE, Bradsher, RW JrCloud, GC, et al.Itraconazole therapy for blastomycosis and histoplasmosis. Am J Med 1992;93:489497.Google Scholar
71.Dismukes, WE, Cloud, G, Bowles, C, et al.Treatment of blastomycosis and histoplasmosis with ketoconazole: results of a prospective randomized clinical trial. Ann Intern Med 1985;103:861872.Google Scholar
72.Sharkey-Mathis, PK, Velez, J, Fetchick, R, Graybill, JR. Histoplasmosis in the acquired immunodeficiency syndrome (AIDS): treatment with itraconazole and fluconazole. J Acquir Immune Defic Syndr 1993;6:809819.Google Scholar
73.Negroni, R, Taborda, A, Robles, AM, Arechavla, A. Itraconazole in the treatment of histoplasmosis associated with AIDS. Mycoses 1992;35:281287.Google Scholar
74.Wheat, J, Hafner, R, Wulfsohn, M, et al.Prevention of relapse of histoplasmosis with itraconazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1993;118:610616.Google Scholar
75.Wheat, J, Connolly-Stringfield, PA, Baker, RL, et al.Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature. Medicine 1990;69:361374.Google Scholar
76.Borelli, D. A clinical trial of itraconazole in the treatment of deep mycoses and leishmaniasis. Rev Infect Dis 1987;9(suppl 1):S57S63.Google Scholar
77.Restrepo, A, Gomez, I, Robledo, J, Patino, MM, Cano, LE. Itraconazole in the treatment of paracoccidioidomycosis: a preliminary report. Rev Infect Dis 1987;9(suppl 1):S51S56.Google Scholar
78.Naranio, MS, Trujillo, M, Munera, MI, Restrepo, P, Gomez, I, Restrepo, A. Treatment of paracoccidioidomycosis with itraconazole. J Med Vet Mycol 1990;28:6776.Google Scholar
79.Tucker, RM, Denning, DW, Arathoon, EG, Rinaldi, MG, Stevens, DA. Itraconazole therapy for nonmeningeal coccidioidomycosis: clinical and laboratory observations. J Am Acad Dermatol 1990;23:593601.Google Scholar
80.Diaz, M, Puente, R, de Hoyos, LA, Cruz, S. Itraconazole in the treatment of coccidioidomycosis. Chest 1991;100:682684.Google Scholar
81.Tucker, RM, Denning, DW, Dupont, B, Stevens, DA. Itraconazole therapy for chronic coccidioidal meningitis. Ann Intern Med 1990;112:108112.Google Scholar
82.Lavalle, P, Suchil, P, De Ovando, F, Revnoso, S. Itraconazole for deep mycoses: preliminary experience in Mexico. Rev Infect Dis 1987;9(suppl 1):S64S70.Google Scholar
83.Restrepo, A, Robledo, J, Gomez, I, Tabares, AM, Gutierrez, R. Itraconazole therapy in lymphangitic and cutaneous sporotrichosis. Arch Dermatol 1986;122:413417.Google Scholar
84.Sharkey-Mathis, PK, Kauffman, CA, Graybill, JR, et al.Treatment of sporotrichosis with itraconazole. Am J Med 1993;95:279285.Google Scholar
85.Winn, RE, Anderson, J, Piper, J, Aronson, NE, Pluss, J. Systemic sporotrichosis treated with itraconazole. Clin Infect Dis 1993;17:210217.Google Scholar
86.al-Fouzan, AS, al-Saleh, QA, Najem, NM, Rostom, AI. Cutaneous leishmaniasis in Kuwait. Clinical experience with itraconazole. Int J Dermatol 1991;30:519521.Google Scholar
87.Albanese, G, Giorgetti, P, Santagostino, L, Crippa, D, Sala, G. Cutaneous leishmaniasis. Treatment with itraconazole. Arch Dermatol 1989;125:15401542.Google Scholar
88.Dogra, J, Aneja, N, Lal, BB, Mishra, SN. Cutaneous leishmaniasis in India. Clinical exnerience with itraconazole (R51 211 Janssen). Int J Demzatol 1990;29:661662.Google Scholar
89.Sharkey, PA, Graybill, JR, Rinaldi, MG, et al.Itraconazole treatment of phaeohyphomycosis. J Am Acad Dermatol 1990;23:577586.Google Scholar
90.Ganer, A, Arathoon, E, Stevens, DA. Initial experience in therapy for progressive mycoses with itraconazole, the first clinically studied triazole. Rev Infect Dis 1987;9(suppl 1): S77S86.Google Scholar
91.Thunnissen, PL, Sizoo, W, Hendriks, WD. Safety and efficacy of itraconazole in preventing fungal infections in neutropenic patients. Neth I Med 1991;39:8491.Google Scholar
92.Boogaerts, MA, Verhoef, GE, Zachee, P, Demuynck, H, Verbist, L, De Beule, K. Antifungal prophylaxis with itraconazole in prolonged neutropenia: correlation with plasma levels. Mycoses 1989;32(suppl 1):103108.Google Scholar
93.Persat, F, Marzullo, C, Guyotat, D, Rochet, MJ, Piens, MA. Plasma itraconazole concentrations in neutropenic patients after reneated high-dose treatment. Eur J Cancer 1992;28:838841.Google Scholar
94.Van't Wout, JW, Novakova, I, Verhagen, CA, et al.The efficacy of itraconazole against systemic fungal infections in neutropenic patients: a randomized comparative study with amphotericin B. J Infect 1991;22:4552.Google Scholar
95.Tucker, RM, Haq, Y, Denning, DW, Stevens, DA. Adverse events associated with itraconazole in 189 patients on chronic therapy. J Antimicrob Chemother 1990;26:561566.Google Scholar
96.Lavrijsen, APM, Balmus, KJ, Nugteren-Huying, , Roldaan, AC, Van't Wout, JW, Stricker, BHC. Henatic iniurv associated with itraconazole~ Lancet 340;1992:251252.Google Scholar
97.Sharkey, PK, Rinaldi, MG, Dunn, JF, Hardin, TC, Fetchik, RJ, Graybill, JR. High-dose itraconazole in the treatment of severe mycoses. Antimicrob Agents Chemother 1991;35:707713.Google Scholar
98.Phillips, P, Graybill, JR, Fetchick, R, Dunn, JEAdrenal response to corticotropin therapy with itraconazole. Antimicrob Agents Chemother 1987;31:647649.Google Scholar
99.Crane, JK, Hue-Teh, S. Syncope and cardiac arrhythmia due to an interaction between itraconazole and terfenadine. Am/ Med 1993;95:445446.Google Scholar
100.Honig, PK, Wortham, DC, Zamani, K, et al.Terfenadine-ketoconazole interaction, pharmacokinetic and electrocardiomanhic consequences. JAMA 1993;269:15131518.Google Scholar
101.Mathews, DR, McNutt, B, Okerholm, R, Flicker, M, McBride, G. Torsade de pointes occurring in association with terfenadine use. JAMA 1991;266:23752376.Google Scholar
102.Monahan, BP, Ferguson, CL, Killeavy, ES, LLoyd, BK, Troy, J, Cantilena, LR. Torsade de pointes occurring in association with terfenadine use. JAMA 1990;264:27882789.Google Scholar
103.Tucker, RM, Denning, DW, Hanson, LH, et al.Interaction of azoles with rifampin, phenytoin, and carbamazepine: in vitro and clinical observations. Clin Infect Dis 1992;14:165174.Google Scholar
104.Itraconazole. Medical Letter 1993;35:79.Google Scholar
105.Moreno, F, Hardin, TC, Rinaldi, MG, Graybill, JR. Itraconazole-didanosine excioient interaction. JAMA 1993;269:1508.Google Scholar
106.Kwan, JTC, Foxall, PJD, Davidson, DCG, Bending, MR, Eisinger, AJ. Interaction of cyclosporin and itraconazole. Lancet 1987;2:282.Google Scholar
107.Novakova, I, Donnelly, P, De Witte, T, et al.Itraconazole and cyclosporin nephrotoxicity. Lancet 1987;2:920921.Google Scholar
108.Shaw, MA, Gumbleton, M, Nicholls, PJ. Interaction of cyclosporin and itraconazole. Lancet 1987;2:267.Google Scholar
109.Kramer, MR, Marshall, SE, Denning, DW, et al.Cyclosporine and itraconazole interaction in heart and lung transplant recipients. Ann Intern Med 1990;113:327329.Google Scholar
110.Kauffman, CA, Bagnasco, FA. Digoxin toxicity associated with itraconazole therapy. Clin Infect Dis 1992;15:886887.Google Scholar
111.Rex, J. Itraconazole-digoxin interaction. Ann Intern Med 1992;116:525.Google Scholar
112.Sachs, MK, Blanchard, LM, Green, PJ. Interaction of itraconazole and digoxin. Clin Infect Dis 1993;16:400403.Google Scholar