Azole antifungals
(Redirected from Itraconazole)
| Drug monograph · NCLEX study reference | |
| Therapeutic class | Antifungal |
|---|---|
| Pharmacologic class | Azole (ergosterol synthesis inhibitor) |
| Onset / peak / duration | Fluconazole once daily with good oral absorption. |
| Half-life / level | Fluconazole about 30 hours; voriconazole levels sometimes monitored. |
| Routes | PO (oral), IV |
| High-alert (ISMP) | No |
| Black box warning | Yes (see Safety) |
| Antidote / reversal | Supportive care. |
| Pregnancy / lactation | High-dose fluconazole avoided in pregnancy. |
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Azole antifungals — Antifungal; Azole (ergosterol synthesis inhibitor).
Identification
- Therapeutic class: Antifungal.
- Pharmacologic class: Azole (ergosterol synthesis inhibitor).
Pharmacology
- Mechanism of action: Inhibit fungal cell membrane sterol synthesis.
- Onset / peak / duration: Fluconazole once daily with good oral absorption.
- Half-life / therapeutic level: Fluconazole about 30 hours; voriconazole levels sometimes monitored.
Clinical use
- Indications: Candidiasis (oral, esophageal, vaginal, systemic), cryptococcal meningitis, aspergillosis (voriconazole), various systemic fungal infections.
- Usual dose, route, frequency: Fluconazole PO or IV daily; others by infection.
- Maximum dose / adjustments: Reduce fluconazole in renal impairment; voriconazole and itraconazole adjusted by hepatic function.
Safety
- Contraindications: Coadministration with many QT-prolonging and CYP3A4-dependent drugs; ketoconazole and itraconazole in heart failure.
- Black box warning: Oral ketoconazole carries a boxed warning for hepatotoxicity and serious QT-related drug interactions (reserved use); itraconazole carries a boxed warning for negative inotropic effects and heart failure and serious interactions.
- Interactions: Strong CYP inhibition raises levels of warfarin, statins, many drugs; QT-prolonging drugs; antacids and acid reducers lower ketoconazole and itraconazole absorption.
- Pregnancy / lactation: High-dose fluconazole avoided in pregnancy.
- High-alert: No.
Adverse effects
- Common side effects: Nausea, headache, rash; voriconazole causes visual disturbances.
- Serious effects to report: Hepatotoxicity, QT prolongation, severe rash, heart failure (itraconazole).
- Antidote / reversal: Supportive care.
Nursing process
- Assessment before administration: LFTs, cardiac and QT history, interacting drugs.
- Interventions during therapy: Review interacting drugs carefully; monitor liver function.
- Monitor: LFTs, ECG if at risk, infection resolution, vision (voriconazole).
- Evaluation / expected outcome: Resolution of fungal infection.
Patient teaching
- Patient teaching: Report yellowing of skin; voriconazole may cause temporary vision changes and sun sensitivity.
- Notify provider if: Yellowing of skin, dark urine, palpitations, vision changes.
- Administration tips: Many interactions; verify before adding other drugs.