Sporanox (itraconazole) is a broad-spectrum triazole antifungal agent designed for the treatment of serious systemic fungal infections. As a potent inhibitor of ergosterol synthesis, it disrupts fungal cell membrane integrity, offering a critical therapeutic option for both immunocompetent and immunocompromised patients. Its oral formulation ensures systemic bioavailability, making it a cornerstone in medical mycology for combating invasive and superficial mycoses where other antifungals may fail.

Features

• Active ingredient: Itraconazole 100 mg
• Formulation: Capsules for oral administration
• Mechanism: Inhibition of lanosterol 14α-demethylase (CYP51)
• Spectrum: Active against Aspergillus, Blastomyces, Histoplasma, Candida spp.
• Bioavailability: Enhanced by acidic gastric environment; take with food

Benefits

• Effectively treats deep-seated systemic fungal infections that are unresponsive to first-line antifungals
• Provides broad-spectrum coverage against both yeast and mold pathogens
• Oral administration facilitates outpatient treatment and reduces hospitalization needs
• Demonstrates good tissue penetration, including skin, nails, and lungs
• Suitable for long-term suppressive therapy in immunocompromised patients
• Available in both branded and generic formulations for accessibility

Common use

Sporanox is indicated for the treatment of blastomycosis, histoplasmosis (including chronic cavitary pulmonary disease and disseminated non-meningeal histoplasmosis), and aspergillosis (pulmonary and extrapulmonary) in patients who are intolerant of or refractory to amphotericin B therapy. It is also used for onychomycosis of the toenail or fingernail due to dermatophytes, and oral/esophageal candidiasis. Off-label uses include treatment of sporotrichosis, chromoblastomycosis, and certain cases of coccidioidomycosis.

Dosage and direction

For systemic fungal infections: 200 mg once daily; may increase to 200 mg twice daily in severe cases. For life-threatening infections, a loading dose of 200 mg three times daily for the first 3 days is recommended. For onychomycosis: 200 mg once daily for 12 consecutive weeks for toenails, or 6 weeks for fingernails. Must be taken with a full meal to ensure optimal absorption. Capsules should be swallowed whole; do not crush or chew.

Precautions

Hepatic function should be monitored in all patients receiving Sporanox; discontinue if clinical signs of liver disease develop. Not recommended for patients with evidence of ventricular dysfunction or history of heart failure. Use with caution in patients with renal impairment. Avoid concomitant administration with drugs that are highly dependent on CYP3A4 metabolism. Pregnancy Category C: use only if potential benefit justifies potential risk to fetus.

Contraindications

Contraindicated in patients with known hypersensitivity to itraconazole or any component of the formulation. Concomitant administration with certain drugs that prolong QT interval (e.g., quinidine, dofetilide) is absolutely contraindicated. Should not be co-administered with CYP3A4 substrates such as lovastatin, simvastatin, or ergot alkaloids. Contraindicated in patients with clinical evidence of ventricular dysfunction or history of congestive heart failure.

Possible side effects

Common: nausea (∼11%), vomiting (∼5%), diarrhea (∼4%), abdominal pain (∼3%), headache (∼4%), rash (∼3%), elevated liver enzymes (∼3%). Less common: hypertension, hypokalemia, edema, fatigue. Rare but serious: clinical hepatitis, cholestasis, Stevens-Johnson syndrome, congestive heart failure, peripheral neuropathy, hearing loss. Transient or permanent hearing loss has been reported, usually reversible upon discontinuation.

Drug interaction

Sporanox is a potent inhibitor of CYP3A4 and P-glycoprotein. Significant interactions occur with: midazolam, triazolam, quinidine, dofetilide, pimozide, HMG-CoA reductase inhibitors (particularly simvastatin and lovastatin), digoxin, warfarin, cyclosporine, tacrolimus, rifampin, phenytoin, carbamazepine, and proton pump inhibitors. Concurrent use with CYP3A4 inducers may decrease itraconazole plasma concentrations.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for the missed one. Maintain regular dosing schedule to ensure consistent therapeutic levels. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.

Overdose

Symptoms may include nausea, vomiting, diarrhea, and headache. In cases of significant overdose, supportive measures should be instituted, including gastric lavage and administration of activated charcoal. Itraconazole is not dialyzable. No specific antidote exists; manage symptoms and provide supportive care. Cardiac monitoring is advised in cases of substantial overdose.

Storage

Store at room temperature (15-30°C or 59-86°F) in a dry place. Protect from light and moisture. Keep in original container with lid tightly closed. Do not store in bathroom or near kitchen sink. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Sporanox is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to therapy may vary. Always follow your healthcare provider’s instructions regarding dosage, administration, and monitoring. Report any adverse effects to your physician immediately.

Reviews

Clinical studies demonstrate Sporanox efficacy rates of 70-80% in blastomycosis and histoplasmosis, with similar success rates in aspergillosis cases. Dermatological studies show mycological cure rates of 54% for toenail onychomycosis after 12 weeks of therapy. Many clinicians report satisfactory patient outcomes, particularly noting its value in cases refractory to fluconazole. Some reviews note the need for therapeutic drug monitoring in complex cases to ensure adequate serum concentrations.