Friday, 23 October 2009

Itraconazole: how much is too much?

Itraconazole is an antifungal that is known to cause a range of adverse 'side effects'. It is also an important weapon in the clinicians armoury against aspergillosis and other fungal infections, so how do we find out how much to use without causing excessive side effects?

Dose of itraconazole is often difficult to judge accurately as there are several variables which effect blood levels of the drug (e.g. variable absorption from patient to patient) so it is important to base dosage studies on actual levels on the blood. A paper by Lestner goes one step further  to ensure accuracy by using a sophisticated bioassay to measure levels of active itraconazole rather than simply measuring levels of the chemical present in the blood. The chemical is often only partly active so measurement of active itraconazole is a more reliable measurement of real dose.

Using this assay Lestner demonstrated that a level of 17.1mg/L of itraconazole and above was the point at which side effects started to become excessive.

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