Itraconazole

Itraconazole is a triazole antifungal medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Itraconazole is prescribed for fungal infections including:

• Tinea (ringworm) of the body, groin, feet and hands — especially widespread, recurrent or steroid-cream-damaged cases now common across Bangladesh
• Pityriasis versicolor (light or dark patches on the trunk)
• Nail fungus (onychomycosis) of fingernails and toenails
• Oral, oesophageal and vaginal candida infections
• Serious systemic fungal diseases such as histoplasmosis and certain aspergillus infections, under specialist care

A doctor should confirm the diagnosis — many rashes mimic fungus — and decide the correct length of treatment, which differs greatly between skin, nail and internal infections.

Most people complete Itraconazole courses without problems. Possible side effects include:

• Nausea, abdominal pain, indigestion or diarrhoea
• Headache or dizziness
• Skin rash or itching; altered taste
• Temporary rise in liver enzymes on blood tests

Stop the medicine and see a doctor urgently if you notice signs of liver injury — loss of appetite, persistent nausea, dark urine, pale stools or yellow eyes — or of heart failure: unusual breathlessness, swelling of the legs, rapid weight gain or inability to lie flat. Rarely, hearing loss or tingling in the hands and feet can occur; report these as well.

Bangladesh is battling an epidemic of treatment-resistant tinea, fuelled by steroid-mixed "magic" creams and half-finished antifungal courses. So the rule with Itraconazole is firm: complete the entire weeks-long course exactly as prescribed, even when the rash fades after the first week — fungus surviving a short course returns harder to kill.

• Avoid steroid-antifungal combination creams unless a doctor specifically prescribes them
• Tell your doctor about any heart disease — Itraconazole can weaken the heart's pumping and is avoided in heart failure
• Liver function may be checked before and during courses longer than a month; report liver disease beforehand
• Absorption needs stomach acid: take after food and keep antacids, PPIs and H2 blockers 2 hours away

Itraconazole strongly blocks the liver enzyme CYP3A4 and interacts with a long list of medicines — one of the longest of any common drug. Always show your doctor and pharmacist everything you take. Key examples:

• Never combine with simvastatin or lovastatin, oral midazolam or triazolam, ergot medicines, quinidine or certain heart-rhythm drugs
• Domperidone (a common gastric drug in Bangladesh) with itraconazole risks dangerous heart rhythms — avoid
• Levels of warfarin, digoxin, ciclosporin, tacrolimus, steroids and some diabetes pills can rise — monitoring or dose changes may be needed
• Rifampicin, phenytoin and carbamazepine can destroy itraconazole's effectiveness
• Antacids, PPIs and H2 blockers reduce its absorption — separate by 2 hours

Do not take Itraconazole if you:

• Are allergic to itraconazole or other azole antifungals
• Have heart failure or a weakened heart muscle (ventricular dysfunction), unless a specialist judges the fungal infection life-threatening
• Are taking any of the strictly prohibited interacting drugs, such as simvastatin, lovastatin, oral midazolam, triazolam, ergotamine or quinidine
• Are pregnant, when the treatment is for skin or nail fungus — the risk is never justified for these conditions

Severe liver disease also generally rules it out. Women who can become pregnant must use effective contraception during treatment and for the period their doctor advises after stopping.

Pregnancy: Itraconazole is contraindicated in pregnancy for skin and nail fungal infections — animal studies showed harm to the foetus, and these conditions can always wait or be treated topically. It is used in pregnancy only for life-threatening fungal disease when no alternative exists. Women of childbearing age must use reliable contraception during the course and for the time their doctor advises after the last dose, especially after nail-fungus treatment, as the drug lingers in the body for weeks.

Breastfeeding: Itraconazole passes into breast milk, so breastfeeding is best avoided during treatment. Discuss timing and safer alternatives with your doctor before starting Itraconazole.

Store Itraconazole below 30°C in a dry place, protected from light and moisture. Bangladesh's humidity can damage capsules quickly, so keep each capsule sealed in its original blister until the moment you take it — never store loose capsules in a pillbox for long periods. Keep the pack well out of the reach and sight of children.

• Do not refrigerate unless the label says so; avoid bathroom shelves and kitchen heat
• Never use Itraconazole after its expiry date
• For long pulse-therapy schedules, store the unused weeks' strips in their carton in a cool cupboard and return leftover medicine to a pharmacy when treatment ends