Itraconazole is an orally administered
triazole antifungal agent. Its spectrum of activity includes dermatophyte, dimorphic and dematiaceous fungi, yeasts, and some moulds. In clinical trials, mycological cure was attained in approximately 70 to 80, > or = 70 and > or = 80% of patients with, respectively, fingernail and toenail
onychomycosis (200 mg/day for 3 months),
dermatophytosis (100 mg/day for 2 to 4 weeks) and vaginal
candidiasis (400 mg/day for 1 day or 200 mg/day for 3 days). Approximately 20 to 30% of patients with
onychomycosis may relapse after completion of
therapy; relapse rate data are limited for the other indications. Recently developed intermittent regimens of
itraconazole (400 mg/day for 1 week per month for 3 to 4 months) appear to have similar efficacy to standard regimens in the treatment of
onychomycosis. Shorter, higher dosage
itraconazole treatment regimens (200 or 400 mg/day for 1 week) are also beneficial in
dermatomycoses. Discrepancies and limitations of study design hamper conclusions about efficacy relative to other antifungal drugs. Newer intermittent and short course higher dosage
itraconazole regimens have also not been evaluated in comparative studies. Available studies show that the efficacy of
itraconazole appears to be greater than that of
griseofulvin, but similar to or lower than that of
terbinafine in patients with dermatophyte
onychomycosis or cutaneous
fungal infections. Moreover, the efficacy of
itraconazole may be similar to or lower than that of
fluconazole in the treatment of cutaneous
mycoses. Comparative data from patients with acute vaginal
candidiasis suggest that
itraconazole is at least as effective as intravaginal
clotrimazole and oral
fluconazole, and superior to intravaginal
econazole. These results require confirmation. Prescription-event monitoring data indicate that
itraconazole is generally well tolerated. Gastrointestinal disturbances,
dizziness and
headache occur most commonly; liver toxicity has been rarely described. Its usefulness in some clinical situations may be limited because of its ability to interact with various therapeutic agents. In conclusion,
itraconazole along with other established agents should be considered a first-line treatment for patients with extensive or recalcitrant cutaneous
fungal infections, mixed dermatophyte and Candida
onychomycosis or vaginal
candidiasis. It is currently considered a second-line
drug for dermatophyte
onychomycosis; the use of newer intermittent
itraconazole treatment regimens may, however, extend its role in the management of this condition. Although
itraconazole offers greater benefit than conventional
therapies (
griseofulvin and
ketoconazole) in terms of efficacy and tolerability, wider clinical experience is required to determine its merits relative to the newer agents,
terbinafine and
fluconazole.