Itraconazole Caspofungin

Diekema D3 et al Activities of caspofungin, itraconazole, posaconazole, ravuconazole, voriconazole, and amphotericin against 448 recent clinical isolates of filamentous fungi. 3 Clin Microbiol 2003 41 3623. [PMID 12904365]... 

Caspofungin, itraconazole, ketoconazole, posaconazole Systemic corticosteroids, caspofungin, itraconazole, voriconazole, ketoconazole, fluconazole, erythromycins... 

Twenty percent of HIV-infected patients develop fluconazole-resistant Candida albicans isolates after repeated exposure to fluconazole.33 To treat fluconazole-resistant oropharyngeal candidiasis, daily itraconazole for 2 to 4 weeks may be used. Oral itraconazole solution exhibits a mycological cure rate of 88% and a clinical cure rate of 97% in immunocompromised patients.34 Fluconazole-resistant esophageal candidiasis should be treated with intravenous amphotericin B or caspofungin. 

Mucocutaneous candidiasis is generally not life-threatening nor invasive and can be treated with topical azoles (clotrimazole troches), oral azoles (fluconazole, ketoconazole, or itraconazole), or oral polyenes (such as nystatin or oral amphotericin B). Orally administered and absorbed azoles (ketoconazole, fluconazole, or itraconazole solution), amphotericin B suspension, intravenous caspofungin, or intravenous amphotericin B are recommended for refractory or recurrent infections.20... 

In patients who have failed initial therapy (i.e., salvage), liposomal amphotericin products, itraconazole, or the echinocandin caspofungin can be used. Itraconazole has a response rate of approximately 40%.100 Oral itraconazole exhibits erratic absorption the IV formulation is suspended in cyclodextrin, which is eliminated renally, and thus IV itraconazole should be avoided in patients with a creatinine clearance of less than 30 mL/minute (0.29 mL/s m2).103 Itraconazole also has negative inotropic cardiac effects and increases the serum concentrations of medications (e.g., cyclophosphamide, etopo-side, calcineurin inhibitors, and sirolimus). 

Invasive aspergillosis For the treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (ie, amphotericin B, lipid formulations of amphotericin B, itraconazole). Caspofungin has not been studied as initial therapy for invasive aspergillosis. 

Aspergillus species Voriconazole Amphotericin B, itraconazole, caspofungin... 

Candidiasis Intestinal tract, skin, mucous membranes (mouth, pharynx, vagina) Amphotericin B, fluconazole Caspofungin, flucytosine, itraconazole... 

Candida species, torulopsis species Amphotericin B, caspofungin Fluconazole, itraconazole... 

Acyclovir, adefovir, amantadine, aminoglycosides, aztreonam, Cidofovir, itraconazole (IV), methenamine, Amprenavir, caspofungin,... 

Decosterd LA et al (2010) Multiplex ultra-performance liquid chromatography-tandem mass spectrometry method for simultaneous quantification in human plasma of fluconazole, itraconazole, hydroxyitraconazole, posaconazole, voriconazole, voriconazole-N-oxide, anidula-fungin, and caspofungin. Antimicrob Agents Chemother 54 5303-5315... 

In rats, caspofungin did not alter the plasma pharmacokinetics of ketoconazole, a potent inhibitor of CYP3A4 (5). Co-administration of caspofungin 50 mg/ day and itraconazole 200 mg/day to healthy subjects for 14 days did not alter the pharmacokinetics of either drug (15). 

Colburn DE, Giles FJ, Oladovich D, Smith JA. In vitro evaluation of cytochrome P450-mediated drug interactions between cytarabine, idarubicin, itraconazole and caspofungin. Hematology 2004 9(3) 217-21. 

Aspergillus spp. Skin, pulmonary, central nervous system Amphotericin B 1 mg/kg/day 5-flucytosine itraconazole 200-400 mg daily lipid-associated amphotericin B 4-5 mg/kg daily caspofungin 50 mg daily voriconizole 4 mg/kg every 12... 

No pharmacokinetic interaction appears to occur between anidulafungin and voriconazole or between caspofungin and itraconazole. No dosage adjustment of these drugs is necessary if they are used in combination. 

Caspofungin 70 mg on day 1 and 50 mg for the next 13 days did not alter the pharmacokinetics of itraconazole 200 mg daily The pharmaeokinet-ics of caspofungin were also unaltered. No dosage adjustment of either drug appears to be necessary when they are used together. 

Systematic reviews In a systematic review and meta-analysis of 39 randomized controlled trials in more than 8000 patients, the incidence rates of treatment discontinuation owing to adverse reactions in general and liver damage in particular associated with antifungal therapy varied widely [d ]. The pooled risks of treatment withdrawal because of adverse reactions were over 10% for amphotericin B and itraconazole and 2.5-3.8% for fluconazole, caspofungin, and micafimgin. 

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