Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Itraconazole is an anti-fungal drug in the
same class of drugs as fluconazole (Diflucan), ketoconazole (Nizoral), and
miconazole (Micatin, Monistat). It prevents growth of several types of fungi by
preventing the fungi from producing the membranes that surround the fungal
cells. The FDA approved itraconazole in September 1992.
STORAGE: Capsules should be stored at room temperature, 15-25 C
(59-77 F) and protected from light and moisture. Solution should be stored below
25 C (77 C) but not frozen.
PRESCRIBED FOR: Itraconazole is used for the treatment of fungal
infections in both HIV- and non-HIV-infected individuals. It is active against
fungal infections such as aspergillosis, blastomycosis, histoplasmosis, and candidiasis, as well as fungal infection localized to the
toenails and
fingernails (onychomycosis). It also is used for treating patients with fever
and low white blood cell counts who are likely to develop a fungal infection.
DOSING: The usual recommended dose is 200-400 mg daily as a single
dose or two divided doses. Capsules should be taken with a full meal because
food improves absorption. The capsule and liquid are not interchangeable, and
only the liquid form is used for treating oral candidiasis.
DRUG INTERACTIONS: Itraconazole reduces the liver metabolism
(breakdown) of some drugs, resulting in increased blood levels and side effects
from the affected drugs. Life threatening adverse effects occurred when
itraconazole was combined with cisapride (no longer available in the U.S.),
pimozide (Orap), quinidine
(Quinaglute, Quinidex), dofetilide (Tikosyn), or
levomethadyl (Orlaam).
Therefore, itraconazole should not be combined with these drugs. Other drugs
whose blood levels are increased by itraconazole include warfarin (Coumadin),
tolbutamide, glyburide (Micronase, Diabeta, Glynase), glipizide (Glucotrol),
protease inhibitors [for example, indinavir (Crixivan), ritonavir (Norvir),
saquinavir (Invirase, Fortovase)],
midazolam (Versed), triazolam (Halcion),
"statins" (for example, simvastatin or Zocor) and several others.
Clarithromycin (Biaxin), erythromycin, indinavir (Crixivan) or ritonavir
(Norvir) increase blood levels of itraconazole by reducing its elimination from
the liver, resulting in increased side effects of itraconazole.
The term "ringworm" or "ringworms" refers to fungal infections that are on the surface of the skin. A physical examination of the affected skin, evaluation of skin scrapings under the microscope, and culture tests can help doctors make the appropriate distinctions. A proper diagnosis is essential to successful treatment. Among the different types of ringworm are the following: tinea barbae, tinea capitis, tinea corporis, tinea cruris, tinea faciei, tinea manus, tinea pedis, and tinea unguium.
Athlete's foot (tinea pedis) is a skin infection caused by the ringworm fungus. Symptoms include itching, burning, cracking, peeling, and bleeding feet. Treatment involves keeping the feet dry and clean, wearing shoes that can breathe, and using medicated powders to keep your feet dry.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
Tinea versicolor is a fungus infection that mainly affects the skin of young people. Recognized by light or reddish brown spots, and areas lighter than the surrounding skin. Tinea versicolor is caused by yeast actually found in our skin. Factors like heat, humidity, and sweat help it proliferate in people, resulting in a rash that is not contagious to others.
Fungal nails (onychomycosis) may be caused by many species of fungi but the most common is Trichophyton rubrum. Distal subungal onychomycosis starts as a discolored area at the nail's corner and slowly spread toward the cuticle. In proximal subungal onychomycosis, the infection starts at the cuticle and spreads toward the nail tip. Yeast onychomycosis is caused by Candida and may be the most common cause of fungal fingernail.
Histoplasmosis is a disease caused by the Histoplasma capsulatum fungus. Symptoms and signs of this infection are fever, dry cough, chills, malaise, sweats, and abdominal pain. Transmission of the infection occurs when people inhale the spores. Most infections resolve on their own, and resistant infections are treated with itraconazole, ketoconazole, or amphotericin B.
Valley fever (coccidioidomycosis) is a disease caused by the inhalation of the Coccidioides immitis or C. posadasii fungus. Symptoms are flu-like and resolve over two to six weeks. Infection typically requires no treatment, though there are many antifungal drugs to treat valley fever.
Sporotrichosis is a skin infection caused by a fungus called Sporothrix schenckii. The fungus, which may be present in sphagnum moss, thorny plants, or baled hay, enters the skin through punctures and small cuts. Symptoms include painless bumps on the skin near the site of infection. The nodules may open and look like boils. The infection is treated with potassium iodide or itraconazole (Sporanox).
Jock itch is a common, itchy rash of the groin. It can be a very intense itch
with or without a visible red or pink rash in the groin folds and genitals. Jock
itch is primarily a skin condition in men.
The symptoms of jock itch may come and go, and many cases of jock itch resolve
spontaneously without any treatment. Jock itch is primarily seen in the groin,
although it may spread to the inner thighs, genitals (including penis, scrotum,
labia, and vaginal opening), and anus.
While jock itch is frequently noted in otherwise healthy patients, patients
with diabetes and/or obesity are more susceptible. Possible causes of this
common groin itch include irritation from tight or abrasive underwear, excess
moisture, sweating, skin rubbing or friction, allergic problems, fungal
infection, Candida (yeast) infection, and bacterial overgrowth or skin
infection.
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