Sporanox: Advanced Antifungal Therapy for Systemic Infections
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Sporanox (itraconazole) is a broad-spectrum triazole antifungal agent designed for the systemic treatment of serious fungal infections. It is indicated for a range of invasive and superficial mycoses, offering targeted inhibition of ergosterol synthesis in fungal cell membranes. With high oral bioavailability and extensive tissue penetration, Sporanox provides clinicians with a reliable option for managing complex fungal diseases in both immunocompetent and immunocompromised patients. Its well-established efficacy and safety profile make it a cornerstone in antifungal pharmacotherapy.
Features
- Active ingredient: Itraconazole 100 mg
- Formulation: Capsules, oral solution, and intravenous infusion
- Mechanism: Inhibition of lanosterol 14α-demethylase (CYP51)
- Spectrum: Active against Aspergillus, Candida, Histoplasma, Blastomyces, and dermatophytes
- Bioavailability: Enhanced by acidic gastric environment; administration with food recommended
- Half-life: 21–64 hours (dose-dependent)
- Metabolism: Hepatic, primarily via CYP3A4
Benefits
- Effectively treats invasive fungal infections with high clinical cure rates
- Provides broad-spectrum coverage against yeasts, molds, and dimorphic fungi
- Demonstrates excellent penetration into tissues, including skin, nails, and lungs
- Suitable for long-term therapy due to well-characterized safety profile
- Available in multiple formulations for flexible dosing in diverse patient populations
- Reduces risk of relapse in endemic fungal infections when used appropriately
Common use
Sporanox is commonly prescribed for the treatment of blastomycosis, histoplasmosis, aspergillosis (in patients intolerant to amphotericin B), and onychomycosis. It is also used off-label for certain cases of candidiasis, cryptococcosis, sporotrichosis, and tinea corporis/cruris when topical agents are insufficient. In immunocompromised individuals, such as those with HIV/AIDS or undergoing chemotherapy, it serves as both treatment and prophylaxis for fungal infections.
Dosage and direction
Dosage varies by indication:
- Blastomycosis/Histoplasmosis: 200 mg once daily; may increase to 200 mg twice daily if no improvement
- Aspergillosis: 200 mg twice daily
- Onychomycosis: 200 mg once daily for 12 weeks (fingernails) or 12–16 weeks (toenails)
- Oral solution: 100–200 mg daily for oropharyngeal candidiasis
Take capsules with a full meal to maximize absorption. Oral solution should be taken on an empty stomach. Do not interchange formulations without medical supervision. Treatment duration depends on clinical response and may require several months for deep-seated infections.
Precautions
- Monitor liver function tests at baseline and periodically during therapy
- Assess cardiac function in patients with pre-existing cardiac disease; risk of negative inotropy
- Use with caution in renal impairment (IV formulation contraindicated if CrCl <30 mL/min)
- Avoid in patients with ventricular dysfunction or history of heart failure
- Pregnancy Category C: use only if potential benefit justifies potential risk
- Not recommended during breastfeeding due to secretion in milk
Contraindications
- Hypersensitivity to itraconazole or any component of the formulation
- Concurrent administration with certain CYP3A4 substrates (e.g., quinidine, dofetilide)
- Treatment of onychomycosis in patients with evidence of ventricular dysfunction
- Coadministration with drugs that prolong QTc interval
- Patients with known acute porphyria
Possible side effect
Common (≥1%):
- Nausea, vomiting, diarrhea
- Abdominal pain
- Headache
- Rash
- Edema
Less common:
- Elevated liver enzymes
- Hypertension
- Hypokalemia
- Menstrual disorders
- Reversible hearing loss
Rare but serious:
- Congestive heart failure
- Severe hepatotoxicity
- Stevens-Johnson syndrome
- Peripheral neuropathy
Drug interaction
Sporanox is a potent inhibitor of CYP3A4 and P-glycoprotein. Significant interactions include:
- Contraindicated: Quinidine, dofetilide, levacetylmethadol
- Not recommended: Lovastatin, simvastatin, triazolam, oral midazolam
- Requires dose adjustment: Cyclosporine, tacrolimus, digoxin, warfarin
- Reduced efficacy: Antacids, H2 blockers, proton pump inhibitors (separate administration by ≥2 hours)
- Potential two-way interactions: Rifampin, phenytoin, carbamazepine (reduce itraconazole levels)
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule to ensure consistent antifungal activity.
Overdose
Symptoms may include nausea, vomiting, diarrhea, and hearing loss. In cases of significant overdose, symptomatic and supportive care is indicated. Gastric lavage may be considered if presented early. Itraconazole is not dialyzable. Monitor cardiac and hepatic function closely.
Storage
Store capsules and oral solution at room temperature (15–30°C). Protect from light and moisture. Keep the bottle tightly closed. Do not freeze. Keep out of reach of children. Do not use after expiration date.
Disclaimer
This information is for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for diagnosis and treatment decisions. Dosage and indications may vary based on individual patient factors and regional prescribing guidelines.
Reviews
Clinical studies demonstrate Sporanox’s efficacy across multiple indications:
- In a randomized trial of blastomycosis, cure rates of 80–90% were observed with 200–400 mg daily dosing
- For onychomycosis, mycological cure rates of 70–80% after 12-week courses
- Aspergillosis studies show response rates of 39–55% in salvage therapy
- Long-term safety data support use for up to 12 months in appropriate patients
Patient-reported outcomes indicate high satisfaction with nail clearance in onychomycosis, though gastrointestinal side effects are commonly noted. Specialist consensus supports its role as a valuable alternative to newer azoles in specific clinical scenarios.