Systemic candidiasis where other antifungal drugs
inappropriate or ineffective
▶BY MOUTH
▶Child: 5 mg/kg once daily (max. per dose 200 mg), dose
increased in invasive or disseminated disease and in
cryptococcal meningitis, increased to 5 mg/kg twice
daily (max. per dose 200 mg)
▶BY INTRAVENOUS INFUSION
▶Child: 2. 5 mg/kg every 12 hours (max. per dose 200 mg)
for 2 days, then 2. 5 mg/kg once daily (max. per dose
200 mg) for max. 12 days
Pityriasis versicolor
▶BY MOUTH
▶Child 1 month–11 years: 3 – 5 mg/kg once daily (max. per
dose 200 mg) for 7 days
▶Child 12–17 years: 200 mg once daily for 7 days
Tinea pedis|Tinea manuum
▶BY MOUTH
▶Child 1 month–11 years: 3 – 5 mg/kg once daily (max. per
dose 100 mg) for 30 days
▶Child 12–17 years: 100 mg once daily for 30 days,
alternatively 200 mg twice daily for 7 days
Tinea corporis|Tinea cruris
▶BY MOUTH
▶Child 1 month–11 years: 3 – 5 mg/kg once daily (max. per
dose 100 mg) for 15 days
▶Child 12–17 years: 100 mg once daily for 15 days,
alternatively 200 mg once daily for 7 days
Tinea capitis
▶BY MOUTH
▶Child 1–17 years: 3 – 5 mg/kg once daily (max. per dose
200 mg) for 2 – 6 weeks
Onychomycosis
▶BY MOUTH
▶Child 1–11 years: 5 mg/kg daily (max. per dose 200 mg)
for 7 days, subsequent courses repeated after 21 -day
intervals;fingernails 2 courses, toenails 3 courses
▶Child 12–17 years: 200 mg once daily for 3 months,
alternatively 200 mg twice daily for 7 days, subsequent
courses repeated after 21 -day intervals;fingernails
2 courses, toenails 3 courses
Systemic aspergillosis where other antifungal drugs
inappropriate or ineffective
▶BY INTRAVENOUS INFUSION
▶Child: 2. 5 mg/kg every 12 hours (max. per dose 200 mg)
for 2 days, then 2. 5 mg/kg once daily (max. per dose
200 mg) for max. 12 days
▶BY MOUTH
▶Child: 5 mg/kg once daily (max. per dose 200 mg),
increased to 5 mg/kg twice daily (max. per dose
200 mg), dose increased in invasive or disseminated
disease and in cryptococcal meningitis
Histoplasmosis
▶BY MOUTH
▶Child: 5 mg/kg 1 – 2 times a day (max. per dose 200 mg)
Systemic cryptococcosis including cryptococcal meningitis
where other antifungal drugs inappropriate or
ineffective
▶BY MOUTH
▶Child: 5 mg/kg once daily (max. per dose 200 mg), dose
increased in invasive or disseminated disease and in
cryptococcal meningitis, increased to 5 mg/kg twice
daily (max. per dose 200 mg)
▶BY INTRAVENOUS INFUSION
▶Child: 2. 5 mg/kg every 12 hours (max. per dose 200 mg)
for 2 days, then 2. 5 mg/kg once daily (max. per dose
200 mg) for max. 12 daysMaintenance in HIV-infected patients to prevent relapse
of underlying fungal infection and prophylaxis in
neutropenia when standard therapy inappropriate
▶BY MOUTH
▶Child: 5 mg/kg once daily (max. per dose 200 mg), then
increased to 5 mg/kg twice daily (max. per dose
200 mg), dose increased only if low plasma-
itraconazole concentration
Prophylaxis of deep fungal infections (when standard
therapy inappropriate) in patients with haematological
malignancy or undergoing bone-marrow transplantation
who are expected to become neutropenic
▶BY MOUTH USING ORAL SOLUTION
▶Child: 2. 5 mg/kg twice daily, to be started before
transplantation or before chemotherapy (taking care to
avoid interaction with cytotoxic drugs) and continued
until neutrophil count recovers, safety and efficacy not
establishedlUNLICENSED USENot licensed for use in children (age
range not specified by manufacturer).IMPORTANT SAFETY INFORMATION
HEART FAILURE
Following reports of heart failure, caution is advised
when prescribing itraconazole to patients at high risk of
heart failure. Those at risk include:
.patients receiving high doses and longer treatment
courses;
.older adults and those with cardiac disease;
.patients with chronic lung disease (including chronic
obstructive pulmonary disease) associated with
pulmonary hypertension;
.patients receiving treatment with negative inotropic
drugs, e.g. calcium channel blockers.
Itraconazole should be avoided in patients with
ventricular dysfunction or a history of heart failure
unless the infection is serious.lCONTRA-INDICATIONSAcute porphyrias p. 603
lCAUTIONSActive liver disease.history of hepatotoxicity
with other drugs.susceptibility to congestive heart failure
lINTERACTIONS→Appendix 1 : antifungals, azoles
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonAlopecia.constipation.
diarrhoea.dyspnoea.gastrointestinal discomfort.
headache.heart failure.hepatic disorders.
hyperbilirubinaemia.hypotension.nausea.oedema.
pulmonary oedema.skin reactions.vision disorders.
vomiting
▶UncommonTaste altered
▶Rare or very rareAngioedema.hypersensitivity vasculitis.
hypertriglyceridaemia.pancreatitis.photosensitivity
reaction.severe cutaneous adverse reactions (SCARs)
▶Frequency not knownPeripheral neuropathy (discontinue)
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶With intravenous useChest pain.confusion.cough.
dizziness.drowsiness.electrolyte imbalance.fatigue.
gastrointestinal disorder.granulocytopenia.heart failure.
hyperglycaemia.hyperhidrosis.hypersensitivity.
hypertension.myalgia.pain.renal impairment.
tachycardia.tremor.urinary incontinence
▶Uncommon
▶With intravenous useDysphonia.hearing loss.numbness.
thrombocytopenia
▶With oral useFlatulence.menstrual disorder376 Fungal infection BNFC 2018 – 2019
Infection5