Itraconazole headache

Toxicological studies have demonstrated that there are no important problems with fluconazole. Therapeutic doses of fluconazole may cause enzyme induction in the Hver. This suggests that interactions with other dmgs cannot be excluded. The side effects are similar to those of itraconazole and include nausea, headache, and vertigo. Occasionally, increased Hver enzymes may be noted. Like itraconazole, fluconazole is contraindicated during pregnancy. 

Buspirone generally is well tolerated and does not cause sedation. Most common side effects include dizziness, nausea, and headaches. Drugs that inhibit CYP3A4 (e.g., verapamil, diltiazem, itraconazole, fluvoxamine, nefa-zodone, and erythromycin) can increase buspirone levels. Likewise, enzyme inducers such as rifampin can reduce buspirone levels significantly. Bupirone may increase blood pressure when coadministered with an monoamine oxidase inhibitor (MAOI). 

Select azole antifungals (e.g., itraconazole, voriconazole, and posaconazole) and the echinocandins are available for IA treatment. For initial therapy of IA, voriconazole had higher response and survival rates than c-AMB.102 An advantage of voriconazole is its 96% oral bioavailability, making use of this oral drug an attractive and less expensive alternative. The dose of voriconazole was 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours for at least 7 days, at which time oral voriconazole 200 mg every 12 hours could be administered. Common toxicities reported with voriconazole include infusion-related, transient visual disturbances (i.e., blurred vision, altered color perception, photophobia, and visual hallucinations), skin reactions (i.e., rash, pruritus, and photosensitivity), elevations in hepatic transaminases and alkaline phosphatase, nausea, and headache.102 In addition, voriconazole increases the serum concentrations of medications cleared by cytochrome P-450 2C9, 2C19, and 3A4 (e.g., cyclophosphamide and calcineurin inhibitors) concomitant voriconazole-sirolimus should be avoided.103... 

PPIs are usually well tolerated. Potential adverse effects include headache, dizziness, somnolence, diarrhea, constipation, nausea, and vitamin B12 deficiency. All PPIs can decrease the absorption of drugs such as ketoco-nazole or itraconazole that require an acidic environment for absorption. Other drug interactions vary with each agent. 

Itraconazole is a triazole antifungal causing side-effects, such as nausea, abdominal pain, dizziness and headache. Itraconazole does not lead to palpitations however, it may lead to heart failure and hence itraconazole is administered with caution to patients at risk of heart failure. 

Itraconazole is usually well tolerated but can be associated with nausea and epigastric distress. Dizziness and headache also have been reported. High doses may cause hypokalemia, hypertension, and edema. Itraconazole, unlike ketoconazole, is not associated with hormonal suppression. Hepatotoxicity occurs in fewer than 5% of cases and is usually manifested by reversible Uver enzyme elevations. 

Adverse Effects. Side effects associated with itraconazole include headache, gastrointestinal disturbances (nausea, vomiting), and skin rash. 

One tablet given daily for 12 weeks achieves a cure rate of up to 90% for onychomycosis and is more effective than griseofulvin or itraconazole. Adverse effects are rare, consisting primarily of gastrointestinal upset and headache. Terbinafine does not seem to affect the P450 system and has demonstrated no significant drug interactions to date. 

Adverse effects Adverse effects include nausea and vomiting, rash (especially in immunocompromised patients), hypokalemia, hypertension, edema, and headache. Drug interactions listed above are also possible with itraconazole. Figure 34.5 summarizes the azole antifungal agents. 

MODAFINIL 1. ANTIBIOTICS-clarithromycin, telithromycin 2. ANTIFUNGALS-itraconazole, ketoconazole 3. ANTIVIRALS-indinavir, nelfinavir, ritonavir, saquinavir t plasma concentrations of modafinil, with risk of adverse effects Due to inhibition of CYP3A4, which has a partial role in the metabolism of modafinil Be aware. Warn patients to report dose-related adverse effects, e.g. headache, anxiety... 

IMATINIB 1. ANTIBIOTICS - clarithromycin, erythromycin 2. ANTIFUNGALS -fluconazole, itraconazole, ketoconazole voriconazole 3. ANTIVIRALS -efavirenz, ritonavir 4. GRAPEFRUIT JUICE 5. H2 RECEPTOR BLOCKERS - cimetidine t imatinib levels with t risk of toxicity (e.g. abdominal pain, constipation, dyspnoea) and of neurotoxicity (e.g. taste disturbances, dizziness, headache, paraesthesia, peripheral neuropathy) Due to inhibition of CYP3A4-mediated metabolism of imatinib Monitor for clinical efficacy and for the signs of toxicity listed, along with convulsions, confusion and signs of oedema (including pulmonary oedema). Monitor electrolytes and liver function, and for cardiotoxicity... 

Itraconazole Topical 1% suspension 1 drop qlh Oral 200 mg PO qd-bid Topical not effective for severe infections, penetrates cornea poorly not commercially available must be compounded Penetrates all eye tissues poorly with oral administration Side effects include hepatotoxicity, gastrointestinal problems, hypokalemia, elevated Uver enzymes, rash, vasculitis, headache, fever, HTN, hypertriglyceridemia Many drug interactions exist including CYP3A4 substrates. Coadministration of itraconazole is contraindicated with multiple antiretrovirals (refer to Table 11-12) Pregnancy category C lactation safety unknown... 

The safety of continuous itraconazole (50-200 mg/day for up to 3 months) in the treatment of onychomycosis and dermatomycosis has been reviewed, using pnblished and unpublished data from clinical trials (15). The overall incidence of adverse events in patients who took continuous itraconazole (21%) differed little from that in patients who took either topical miconazole or oral placebo (18%). The most frequently reported adverse events were gastrointestinal disorders (6.7%), headache (4.2%), and skin disorders (2.7%). No data were given on the incidence of serious adverse events attributed to itraconazole. Among laboratory abnormalities, clinically significant rises in liver function tests occurred in 3.4% of 527 patients treated with itraconazole (2.6% in patients treated with 50-200 mg/day for dermatomycosis versus 6.6% in patients treated with 200 mg/day for 3 months for onychomycosis). 

In patients taking itraconazole capsules for prolonged periods the common adverse effects were nausea and vomiting (in under 10%), hypertriglyceridemia (9%), hypokalemia (6%), raised transaminases (5%), rashes and/or pruritus (2%), headache or dizziness (under 2%), and foot edema (1%) (23). 

Headache due to itraconazole has been mentioned in some reports (27). Dizziness is an uncommon complaint, as are mood disturbances. 

The common adverse effects of itraconazole are similar to those of terbinaflne, such as gastrointestinal disturbance, dermatologic disorders, and headache less common adverse effects include dizziness, fatigue, fever, decreased libido, and asymptomatic liver enzyme abnormalities (1% to 5% with continuous dosing and about 2% with... 

The toxicity of LEF is similar to MTX (133,134). The most commonly reported side effects are diarrhea, nausea, alopecia, rash, and headache (135). Anecdotally, alopecia seems more common with LEF than with MTX. However, diarrhea and nausea are more common with MTX. LEF has been successfully used in patients who have discontinued MTX due to GI toxicity (97). Although the rate of liver function abnormalities appears similar to that observed with MTX, the rate of severe liver toxicity is lower with LEF (135). Severe toxicity has been mostly reported when LEF is combined with other hepatotoxic agents such as MTX (136) or itraconazole (137). 

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