Itraconazole

About Itraconazole

Itraconazole blocks an enzyme fungi need to build their cell membrane. The Sporanox capsule label approves it for blastomycosis, histoplasmosis and aspergillosis (when amphotericin B fails or is not tolerated), and, in people with a normal immune system, for toenail and fingernail fungus. For blastomycosis and histoplasmosis the usual dose is 200 mg once daily, raised up to 400 mg a day if needed, for at least three months; toenail fungus takes 200 mg once daily for 12 weeks. The oral solution is approved for thrush of the mouth and esophagus. Tolsura 65 mg capsules treat the same systemic infections in adults, not nail fungus. Safety in children has not been established.

The boxed warning says itraconazole can cause or worsen congestive heart failure. It must not be used for nail fungus in anyone with heart failure or a history of it. It also names many medicines that must not be taken with it because itraconazole raises their levels and can make their side effects serious, including dangerous heart rhythms with some of them; examples include methadone, quinidine, dofetilide, pimozide, triazolam, oral midazolam, felodipine, simvastatin, lovastatin and ticagrelor. Other warnings cover rare serious liver injury, nerve damage, hearing loss and high blood pressure with low potassium. The most common side effects in the systemic infection studies were nausea, rash, vomiting, edema and headache.

What is distinctive is that the oral forms are not interchangeable: the solution gives higher blood levels than capsules, and Tolsura cannot be substituted for any other itraconazole product. Capsules go with a full meal; the solution is taken without food. It must not be used for nail fungus in pregnancy or when planning one; for nail fungus in women who could become pregnant, the label asks for highly effective birth control during treatment and for two months after. For serious infections in pregnancy, it is used only if the benefit outweighs the risk. The discontinued injection is not covered here. Itraconazole is not a controlled substance.

Taking Itraconazole

How to take it

Swallow capsules whole with a full meal; do not open, chew or crush them. Take the oral solution without food, swishing it in the mouth for several seconds before swallowing.

If you miss a dose

Take the missed dose as soon as you remember, unless it is almost time for the next one; then skip it and go back to your usual schedule. Do not take a double dose.

Storage

Keep it in the original container, tightly closed, at room temperature, away from heat, light and moisture and out of reach of children. Do not freeze the oral solution.

Interactions to know about

Tell the pharmacist about everything you use. Take antacids two hours before or two hours after itraconazole, do not start acid reducers such as famotidine or omeprazole without asking the prescriber, and ask the doctor about grapefruit juice.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Itraconazole differs from pharmacy to pharmacy

Quotes depend first on which product the prescription names. The 100 mg capsule has several generic makers, so most quotes for it are for a generic, while a prescription for the Sporanox brand with substitution blocked is priced as a brand. Tolsura, a 65 mg brand capsule, is priced as a brand and cannot be swapped for a generic capsule. The oral solution comes from fewer makers.

Courses run from weeks to months, so fill sizes vary widely, and on a short fill the dispensing fee is a larger share of the quote.

Ways to pay less for Itraconazole without insurance

• If the prescription is for Sporanox capsules, ask the prescriber to allow generic substitution, since AB rated generic 100 mg capsules can be swapped at the counter.
• If the prescription is for Tolsura, ask the prescriber whether generic 100 mg capsules would suit, since the two are not interchangeable without a new prescription.
• Compare more than one pharmacy for the same capsule count, and ask whether it stocks the exact form prescribed.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Itraconazole

1. 1.Do any of my medicines, including heart, cholesterol or sleep medicines, interact with my itraconazole?
2. 2.Is my prescription for capsules or oral solution, and should I take it with food or on an empty stomach?
3. 3.How should I space my antacid or acid reducer around my itraconazole doses?
4. 4.Which signs of heart, liver or hearing problems mean I should call my doctor right away?

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