Background: ITRACONAZOLE is believed to carry a low risk of hepatic toxicity owing to its low affinity for the human P-450 enzyme. Therefore, hepatic failure caused by ITRACONAZOLE is exceedingly rare.Objectives: We report the case of a 46-year-old woman who developed hepatic failure related to ITRACONAZOLE that was administered for the treatment of onychomycosis. Her condition deteriorated after withdrawal of the drug, followed solely by supportive care initially.Case Report: Treatment with corticosteroids was started 10 days after her admission, and her condition gradually improved. Unfortunately, her condition worsened when the dosage of corticosteroids was abruptly decreased. Ultimately, her condition improved with appropriate adjustments of corticosteroid dosage.Discussion: We conclude that corticosteroid therapy may be effective for ITRACONAZOLE-induced hepatitis, especially in those patients who do not respond to conservative treatment. Notably, any decrease in the dosage should be performed with caution. We also recommend that close monitoring of liver function is mandatory during the use of ITRACONAZOLE.

Background and Purpose: Candida parapsilosis isolates usually have a low minimum inhibitory concentration (MIC) against azoles. Although Candida parapsilosis isolates usually have low MICs against azoles, recent studies candida invasive infections due to azole resistant-C. parapsilosis isolates. Regarding this, the main aim of this study was to determine the susceptibility pattern of Iranian clinical C. parapsilosis against available azole antifungal drugs. Materials and Methods: This study was conducted on 105 previously-identified isolates of C. parapsilosis sensu stricto. For the purpose of the study, the isolates were subjected to antifungal susceptibility testing against fluconazole (FLZ), ITRACONAZOLE (ITZ), voriconazole (VRZ), and two new azole drugs, namely luliconazole (LUZU) and lanoconazole (LZN). The broth microdilution reference method adopted in this study was according to the Clinical & Laboratory Standards Institute M27-A3 and M27-S4 documents. Results: According to the results, 89% (n=94) of C. parapsilosis isolates showed a MIC of ≥ 1 µ g/ml, indicating resistance against ITZ. Multi-azole resistance was observed in 3. 8% of the isolates. In addition, LUZU and LZN demonstrated the highest efficacy with the MIC50 values of 0. 5 and 1 µ g/ml, respectively. Conclusion: The majority of the isolates showed high MIC values against ITZ. This may have been associated with the long-term ITZ prophylaxis/therapy in patients infected with candidiasis. Hence, the adoption of an appropriate antifungal agent is a crucial step for starting the treatment.

Background and the purpose of the study: ITRACONAZOLE is a poorly water soluble drug which results in its insufficient bioavailability. The purpose of the present study was to formulate ITRACONAZOLE in a nanosuspension to increase the aqueous solubility and to improve its formulation related parameters, dissolution and hence oral bioavailability.Methods: ITRACONAZOLE nanosuspension was prepared by pearl milling technique using zirconium oxide beads as a milling media, Poloxamer 407 as a stabilizer and glycerol as a wetting agent. Effects of various process parameters like, stirring time and the ratio of the beads were optimized by keeping drug:surfactant: milling media (1:3.0:50) as a constant initially and then optimized process parameters were used to optimize formulation parameters by 32 factorial designs. The optimized nanosuspension was lyophilized using mannitol (1:1 ratio) as a cryoprotectant. Nanosuspension was characterized by particle size and size distribution, drug content, scanning electron microscopy, differential scanning colorimetry and X-ray diffraction techniques.Results: Optimized nanosuspension showed spherical shape with surface oriented surfactant molecules and a mean particle diameter of 294 nm. There was no significant change in crystalline nature after formulation and it was found to be chemically stable with high drug content.Conclusion: The in vitro dissolution profile of the optimized formulation compared to the pure drug and marketed formulation (Canditral Capsule) by using 0.1N Hydrochloric acid as release medium showed higher drug release.

OBJECTIVE: To evaluate the efficacy of a single use of ITRACONAZOLE for treating Penicillium marneffei infection in HIV-infected patients, help to develop a clinical medication regimen, and provide a scientific basis for treatment measures.METHOD: A computerised literature search was carried out using the PubMed, EMbase, Ovid, Web of Science, Science Direct and CNKI (China National Knowledge Infrastructure) databases to collect relevant articles (from their establishment date to August 2014) using the following Itraconaz or Sporanox, HIV, AIDS, Penicillium marneffei (PSM), and Treatment. All related RCTs (Randomised Controlled Trials) were screened. Stata12.0 was used to conduct the meta-analysis to calculate the RR (relative risk) and 95% CI (confidence intervals). After that the consistency test, followed by the bias, was evaluated.RESULTS: Five RCT papers were finally enrolled, with 467 persons in total. Among them, 192 individuals were enrolled in the experimental group, of which 37 individuals (19.27%) died during the course of the study. The number of participants in the control group was 275, and of these, 55 individuals (18.55%) died over the course of the study. The meta-analysis showed that the RR and 95% CI was 1.03 and 0.69 –1.54, P > 0.05, indicating that single-use ITRACONAZOLE for the treatment of Penicillium marneffei infection in HIV-infected patients was non-effective. The publication bias analysis results showed that the funnel chart was symmetrical, indicating that the effect of publication bias in this research can be ignored.CONCLUSION: Single-use of ITRACONAZOLE for the treatment of Penicillium marneffei infection in HIV-infected patients is non-effective.