Wednesday, 12 May 2010

Vitamin C acidic beverage is a good alternative to cola when taking itraconazole

People taking antacids (or who have other absorption problems) and the antifungal itraconazole have long been advised to take a cola drink with their antifungal in order to aid its uptake into the bloodstream. Other acidic drinks have also been used, most notably acidic fruit juice which has proven to have problems of its own, sometimes improving uptake but decreasing breakdown of the drug in the liver (overall effect can be to over-increase the levels of itraconazol in the blood) and sometimes to actually block uptake. Obviously care needs to be taken when taking fruit juices!

Cola can be unpalatable to some patients and as it contains a fair amount of caffeine and sugar it can have other unwanted effects, particularly for diabetics.

This paper has examined the use of a vitamin C drink which contains no caffeine for improving uptake of  itraconazole. This drink is shown to be very effective at enhancing uptake of itraconazole and the presence of its metabolite 7-hydroxyitraconazole (which also functions as an antifungal in addition to itraconazole, increasing its potency). It is shown to be very similar to cola, so this is a genuine alternative to cola and fruit juice for itraconazole users.

Is there is something about vitamin C that enhances uptake of itraconazole? This paper shows no such thing and states that this vitamin C drink had a similar pH (acidity) to cola. The acidity of the drink has always been stated to be what is important when choosing a drink to use to improve absorption of itraconazole - this drink is acidic so that is likely to be the reason why it helps rather than any specific activity of vitamin C.

The vitamin C drink also contains added fructose & fruit juices so will contain a fair quantity of sugar.

By all means consider drinks like this to help absorption of your itraconazole if you find it a pleasant alternative to cola, but think again if you need to avoid sugar!

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