Rashes itraconazole

All azole antifungals carry the potential for rash, photosensitivity, and hepatotoxicity. In general, hepatotoxicity is mild and reversible, presenting as asymptomatic increases in liver transaminases. However, fulminant hepatic failure has been reported with itraconazole. Therefore, serial monitoring of liver function... 

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... 

WARNING Chemo agent handle w/ caution Uses Hodgkin Dz NHLs, mycosis fungoides, CAs (testis, renal cell, breast, NSCLC), AIDS-related Kaposi sarcoma, choriocarcinoma, histiocytosis Action X Microtubule assembly Dose 0.1-0.5 mg/kg/wk (4-20 mg/m ) X in hepatic failure Caution [D, ] Contra IT use Disp Inj SE i BM (esp leukopenia), NA, constipation, neurotox, alopecia, rash, myalgia, tumor pain Interactions T Effects W/ erythromycin, itraconazole X effects W/ glutamic acid, tryptophan X effects OF phenytoin EMS T Risk of... 

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

Voriconazole is the newest triazole to be licensed in the USA. It is available in intravenous and oral formulations. The recommended dosage is 400 mg/d. The drug is well absorbed orally, with a bioavailability exceeding 90%, and exhibits less protein binding than itraconazole. Metabolism is predominantly hepatic, but the propensity for inhibition of mammalian P450 appears to be low. Observed toxicities include rash, elevated hepatic enzymes, and transient visual disturbances. 

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. 

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... 

Amphotericin and itraconazole have been compared in a multicenter, open, randomized study in 277 adults with cancer and neutropenia (54). Itraconazole oral solution (100 mg bd, n — 144) was compared with a combination of amphotericin capsules and nystatin oral suspension n — 133). Adverse events were reported in about 45% of patients in each group. The most frequent were vomiting (14 versus 12 patients), diarrhea (12 versus 9 patients), nausea (5 versus 12 patients), and rash (2 versus 13 patients). There were no differences in liver function... 

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). 

Different tjrpes of rash, including a case of acneiform rash, have been reported in patients taking itraconazole. In one case there were bloody bullae (SED-12, 680) (40-43). 

Relative to capsules, the oral solution of itraconazole more frequently causes diarrhea, abdominal cramps, anorexia, and nausea. GI side effects are common, but adherence generally is unimpaired. Anaphylaxis and severe rash have rarely occurred. 

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