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& OBJECTIVE: Considering the high prevalence of vaginal candidiasis and its complications, selection of the best medical treatment based on clinical and microscopic findings, decrease of recurrence rate, short term of therapy with oral agents is so important. The aim of this study was to compare a 3-day course of oral ITRACONAZOLE versus 7-day course of vaginal clotrimazole for the treatment of vulvo vaginal candidiasis.METHODS: This study was performed on 100 women with clinical and mycological diagnosis of vaginal candidisis who referred to Babol Yahyanejad hospital during one year. They were randomly divided into two groups, those who were treated with vaginal clotrimazole (100 mg/daily for 7 days) and those treated with oral ITRACONAZOLE (200mgldaily for 3 days). All were followed for 14 and 45 days after treatment. The results of treatment and recurrence rate were recorded. FINDINGS: In clotrimazole regimen, 36 (72%) patients were cured clinically and 30 (6%) patients were cured microscopically. In ITRACONAZOLE regimen, 39 (78%) cases were cured clinically and 35 (70%) patients were cured microscopically. Twenty nine cases did not complete the treatment (16 cases of ITRACONAZOLE and 13 of clotrimazole group). In clotrimazole group, clinical and microscopical recurrence rate was 41.2% and 61.8%, respectively. In ITRACONAZOLE group, clinical and microscopical recurrence rate was 35.1% and 48.6%, respectively (p>0.05). There was not seen any intolerance in both agents.CONCLUSION: According to the results, both oral ITRACONAZOLE and vaginal clotrimazole has similar effect in the treatment of vaginal candidiasis. Although, clinical and microscopical improvement and recurrence were a little better in ITRACONAZOLE group.

ITRACONAZOLE is one of the most recent antifungal agents available for treatment of mycoses. In this study 50 patients affected with dermatophytosis including tinea corporis (26 cases), tinea pedis (14) and tinea cruris (10) were treated with systemic ITRACONAZOLE. The patients received 100 mg of systemic ITRACONAZOLE daily for 3-6 weeks, the direct examination and mycological culture from the lesions and SGOT and SGPT tests from the serum of subjects were done before and after treatment. Twelve patients with etiological agent of Trichophyton, mentagrophtes and 3 with Microsporum, canis after 4 weeks of treatment with ITRACONAZOLE and 9 with Epidermophyton floccosum and 16 with T.verrucosum after 3 weeks showed complete cure. Ninety six percent of patients with tinea corporis and 100% with tinea cruris after 4 weeks of treatment showed clinically and mycologically cure whereas, complete cure for tinea pedis obtained after 6 weeks. We could suggest that in chronic cases of dermatophytosis (resistance to other antifungal drugs) ITRACONAZOLE could be effective.    

This study aims to investigate the capability of forming ITRACONAZOLE containing niosomes with Span 60 and Brij 58 as non-ionic surfactants. Lower cost and higher stability makes niosomes a more suitable choice in comparison with liposomes.The capability to form vesicles as an ITRACONAZOLE delivery system and the influence of different factors such as type of surfactant and molar ratio of cholesterol/surfactant on the encapsulation efficiency was investigated. The size distribution of vesicles was measured by laser light scattering method. Based on the results, it was observed that the highest encapsulation efficiency and the smallest vesicle size were associated with the formulation composed of Span 60/cholesterol with the molar ratio of 30:70. The observed results were encouraging, and suggested the possibility of using this vesicle system for delivery of ITRACONAZOLE as a new carrier for treating of fungalinfections.

Background and Objective: Aspergillosis is the most current causative agent of exogenous fungal nosocomial infection. This study was done to evaluate the drug susceptibility of Aspergillus flavus and A.fumigatus to ITRACONAZOLE and amphotericin B.Materials and Methods: This Laboratory study was done on 25 Aspergillus fumigatus and 25 Aspergillus flavus species isolated from transplant's patients. Drug susceptibility test was done according to NCCLS M38-P document. Fungal suspensions of mentioned fungi were supplied with ranges 0.5–5×104 by spectrophotometer at 530 nm. Serial dilutions of drugs were supplied from 0.03125 to 16 mg/ml and MICs determined following 48h incubation at 35oC.Results: Obtained MICs ranges for Aspergillus fumigatus and Aspergillus flavus were 1-4 mg/ml and 0.5–4 mg/ml for ITRACONAZOLE, respectively while MICs ranges against Aspergillus fumigatus and Aspergillus flavus were 0.5-2 mg/ml and 0.25-2 mg/ml for amphotericin B, respectively. Amphotericin B MICs were significantly lower than ITRACONAZOLE (P<0.05).Conclusion: Aspergillus flavus and A. fumigatus were susceptible to amphotericin B and ITRACONAZOLE.

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.