Itraconazole can be used to treat a number of fungal infections or for prophylaxis. Toxic symptoms may develop at elevated blood levels, and monitoring blood levels is recommended during its use.
Adverse effects may include:
(1) fluid retention with peripheral edema
(2) congestive heart failure
(3) nausea and vomiting
(4) flatulence and diarrhea
(5) abdominal pain
(6) toxic hepatitis with abnormal liver function tests
(7) diffuse, nonpruritic maculopapular rash
(8) headache
(9) peripheral neuropathy in a glove and stocking distribution
(10) tremor
(11) sleep disturbances
(12) altered mood
(13) dysgeusia (altered taste)
Lestner et al found that the risk for adverse effects correlated with serum levels using a bioassay. Concentrations reported by bioassay tend to be higher than those seen by HPLC. In addition, results were reported as mean levels rather than peak and trough.
Mean Serum Level
Risk of Adverse Effects
< 5 mg/L
subtherapeutic
5 to 6.9 mg/L
low
7 to 17 mg/L
variable
>= 17.1 mg/L
high
If the patient is symptomatic when the serum level is high and asymptomatic when it is low then adverse reactions is assumed to be concentration-dependent.
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