Adult

Itraconazole

General Information

Triazole antifungal 

Restricted formulary antimicrobial: For details see OUH netFormulary

Itraconazole tablets and oral suspension are NOT interchangeable. Seek advice from Pharmacy if changing between formulations.

For all information regarding contra-indications, interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).

Standard dose

Oral itraconazole: Dose is indication specific. See Summary of Product Characteristics or BNF for dosing information.

Intravenous itraconazole: 

 

IV itraconazole

Loading dose 

200mg iv bd for 48 hours

Maintenance dose (Day 3 onwards)

200mg iv od

 

Renal and hepatic impairment

Renal impairment

  • Oral: No dose adjustment required but carry out therapeutic drug monitoring.
    • The oral bioavailability of itraconazole may be reduced in patients with renal insufficiency
  • IV:
    • Creatinine clearance of 30ml/min or more: No adjustment required. Monitor U&Es regularly.
    • Creatinine clearance less than 30ml/min: AVOID. Use is contra-indicated by manufacturer.
      • This is because Hydroxypropyl-β-cyclodextrin, an excipient of the itraconazole intravenous formulation, is eliminated through glomerular filtration.
      • Consider changing to oral itraconazole or alternative antifungal. Discuss with Micro/ID.

 

Hepatic impairment

Therapeutic Drug Monitoring

Therapeutic Drug Monitoring is required. See Therapeutic Drug Monitoring (TDM) for Antifungal Agents

Additional information

The OUH Antifungal Patient Information Leaflet can be found HERE

References

  • Neon Healthcare Ltd. Summary of Product Characteristics. Itraconazole 10mg/ml concentrate and solvent for solution for infusion. [online]. Last revision of the text: 2/2/22. Accessed via: www.emc.medicines.org.uk Accessed 12/5/25

  • Janssen-Cilag Ltd. Summary of Product Characteristics. Sporanox 100mg capsules. [online] Last revision of the text: 8/11/23. Accessed via Medicines and Healthcare Products Regulatory Authority Products webpage https://products.mhra.gov.uk/search/?search=itraconazole&page Accessed 12/5/25

  • Janssen-Cilag Ltd. Summary of Product Characteristics. Sporanox 10mg/ml oral solution. [online] Last revision of the text:11/12/24. Accessed via Medicines and Healthcare Products Regulatory Authority Products webpage https://products.mhra.gov.uk/search/?search=itraconazole&page Accessed 12/5/25

  • The Renal Drug Database. Itraconazole. [online]. Last updated: 11/8/24. Accessed via: https://renaldrugdatabase.com Accessed 12/5/25

  • Sanford Guide. Itraconazole [Internet] Last revision of the text: 24/3/25. Accessed 12/5/25

  • Sanford Guide. Obesity dosing adjustment [Internet] Last revision of the text: 25/4/25. Accessed 12/5/25