Talk:Itraconazole

pKa-value?

We should write pKa value systematically in all medicine substance articles? — Preceding unsigned comment added by 194.100.75.169 (talk) 14:26, 7 February 2013 (UTC)

Scary wrong

Whoever wrote that neurologists use itraconazole for CNS infections, good luck. The drug doesn't enter CNS. - Emt147 ^Burninate! 01:07, 27 December 2006 (UTC)

Itraconazole HAS been prescribed for fungal meningitis

Actually, as I wrote, it has been prescribed for fungal meningitis, specifically meningitis caused by the spores of valley which are inhaled, causing pneumonia and then moves to infect the meninges, which is called fungal meningitis.

Here is my source which you can access; can you provide your source which I can access electronically?

"Itraconazole was reported to be potentially efficacious for coccidioidal meningitis" Citation: Tucker RM, Denning DW, Dupont B, Stevens DA. Itraconazole therapy for chronic coccidioidal meningitis. Ann Intern Med 1990; 112:108–12.

It has also been used in cats and dogs: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75BB-4HDNVHP-5&_user=4421&_coverDate=11%2F30%2F2005&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000059598&_version=1&_urlVersion=0&_userid=4421&md5=8d6f9031c7864edee2844bdcddb74a01#SECX8

128.120.57.223 23:49, 15 February 2007 (UTC)

My source is the Sanford Guide to Antimicrobial Therapy and clinical experience. You might be able to reach therapeutic CNS levels over time but certainly not in acute infections, and cocci meningitis is rather uncommon. To quote the Hopkins Antibiotic Guide (http://www.hopkins-abxguide.org), Negligible CSF penetration, however treatment has been successful for cryptococcal and coccidioidal meningitis. - Emt147 ^Burninate! 05:26, 16 February 2007 (UTC)

Even if cocci meningitis is rather uncommon, it does not eliminate the possibility that itraconazole is an effective treatment. Please see this article from the annals of internal medicine:

http://www.annals.org/content/112/2/108.abstract?ck=nck

And please also see this article which shows that although intraconazole by itself may have difficulties maintaining concentrations in the brain, additional medications will help increase it's ability to cross the blood brain barrier:

http://www.ncbi.nlm.nih.gov/pubmed/9661014

In conclusion, itraconazole HAS been prescribed as treatment for meningitis. I was not wrong.

71.137.214.216 14:42, 8 March 2007 (UTC)

it says it right there!

it doesn't seem as though the source of the information is not credible, rather that the information extrapolated from that source is incorrectly stated on this wiki page

you have just admitted that therapeutic levels can be obtained over time, and that itraconazole can be effective for treating cocci meningitis, regardless of how common it is or not.

To quote Sanford's (the leading guide for antimicrobial therapy used by physicians): "do not use to treat meningitis". If you have a better source, cite it. Removing cited material is vandalism and I will treat it as such. - Emt147 ^Burninate! 23:48, 24 May 2007 (UTC)

read carefully!

Again, I am NOT questioning your source; I am questioning YOUR interpretation of the information. To quote YOUR source the second line agent for coccidioides immitis (a fungus causing MENINGITIS) is ITRACONAZOLE! (http://www.hopkins-abxguide.org/terminals/diagnosis_more.cfm?id=26&fc=pt)

The source is perfectly correct; it is YOU who are mistaken. Read your source thoroughly next time for clarification.

YOU quoted Hopkins supporting the fact that itraconazole CAN be used to treat meningitis "Negligible CSF penetration, however treatment has been successful for cryptococcal and coccidioidal meningitis" (http://www.hopkins-abxguide.org/terminals/antibiotics_more.cfm?id=81&fc=p), just in case you did not understand that statement I will repeat it, "TREATMENT HAS BEEN SUCCESSFUL FOR CRYPTOCOCCAL AND COCCIDIOIDAL MENINGITIS"(http://www.hopkins-abxguide.org/terminals/antibiotics_more.cfm?id=81&fc=p), you even quoted that same line yourself!

Btw, I’m pretty sure YOU didn't site or give a link to the exact page of your 'new' information. Where does it say, "do not use [itraconazole] to treat meningitis" as I have just pointed out, Itraconazole is used in patients who do not respond well to Fluconazole and/or Amphotericin b

I do not think you understand the severity of your misinformation. Patients, doctors, and families can look upon this information for a victim of coccidiodal meningitis and suggest the use of itraconazole, but if you continue to insist that itraconazole cannot be used for meningitis, you dangerously mislead vulnerable people. Unless you have definitive, non contradicting information, please stop claiming that itraconazole cannot be used for meningitis. To be clear, it is not used for all types of meningitis, but it does work for the 2 mentioned above.

If you do provide definitive proof that Itraconazole cannot be used for coccidioidal meningitis, I would genuinely appreciate the quote and source if the information. Apr03 08:38, 28 May 2007 (UTC)

Wrong molecular structureSunx0053 (talk) 18:09, 19 December 2008 (UTC)

The present molecular structure is missing a bezene ring in the middle. Please correct.Sunx0053 (talk) 18:09, 19 December 2008 (UTC)

You are right. I have replaced the image with a correct one. Thanks for catching the error. -- Ed (Edgar181) 18:24, 19 December 2008 (UTC)

Insolubility claim true? If so, how is the IV preparation made?

I kind of need this info, in a bad way. Anyone know? Aadieu (talk) 03:08, 12 February 2010 (UTC)

Significantly different preparation being marketed

A product with significantly different absorbtion/bioavailability properties is beginning to be marketed. Itraconazol, being something of an orphan, may well be sensitive to marketing spend (without comment on the advantages or otherwise of the competor brand). To the extent that 'Lozanoc' replaces 'Sporinox' in the marketplace, a good deal of the information about dosing and bioavailability on this page will need to be rewritten. In the meantime, it will all just be confusing — Preceding unsigned comment added by Jhunt29 (talk • contribs) 08:23, 25 May 2014 (UTC)

Both Explanations are Slightly Correct

The half life of Itraconazole in the brain is extremely short, it crosses the barrier just fine. No need for major dose increases. The improved effect comes from spaced out dosing for oral, or continuous IV administration. This keeps the medication in the brain longer. Why itraconazole is rapidly eliminated from the blood brain region is not yet fully understood. The reason for altering and creating new itraconazole formulations is for the benefit of improved treatment, not because it doesen't work.

There are people out there who self medicate although this can be unsafe, do not exceed the recommended dosing as stated in a section above, this will not help. If it did help you would find great increases of recommended dosing for menningitis on every pharmacy drug site across the web, meaning the Professional Powers That Be have already made the necessary adjustments for the Blood Brain Barrier. Also finding recommended doses on these pharmacy sites for menningeal infection means it does work, meaning it does cross the BBB. This is not rocket science. To achieve better BBB results, use the same daily mg requirement and divide the dose more throughout the day in oral dosing. You want 3-4 seperate doses not exceeding the daily mg recommendations or length of recommended treatment. Exceeding the recommended dosing causes liver damage and heart arrythmias due to prolongated QT intervals. Such an arrythmia can cause sudden death. Both mentioned symptoms can also be a side effect of regular dosing, stop the medication and contact your physician about arrythmias or symptoms of liver problems. If you are self treating against or without medical advise, stop period.

Always increase fluids with any medication unless otherwise stated by your physician, this reduces liver and kidney toxicity risk but does not prevent. The body needs treated with the medication, it does not need to store it, help your body clean it back out. Self medicators please do not exceed recommended dosages, medications require a prescription because they are recognized as unsafe. The purpose of your physician and pharmacy is to know how much SHOULD be ok for your treatment(benefit outweighs the risk)and be there for you if it isn't working out.

I am not including references because much is still under study and not completely understood, information continues to change regularly. — Preceding unsigned comment added by 96.43.36.206 (talk) 19:08, 29 March 2015 (UTC)

Correct skeletal formula and IUPAC name

Chiral centers are marked by asterisks

Four diastereomers of itraconazole

It is known that itraconazole molecule has three chiral carbons, but the drug itself is a mixture of only four diastereomers (two enantiomeric pairs). Source: Stereochemical Aspects of Itraconazole Metabolism in vitro and in vivo, fig. 1, also Itraconazole on Drugs.com. They can be seen on the picture. Taking into consideration that such a huge skeletal formula is unsuitable for the drugbox template, how can one "contract" it correctly to portray the existence of all four diastereomers? Also, current IUPAC name is doubtful. As mentioned on Drugs.com link, I guess it should be (±)-1-[(RS)-sec-butyl]-4-[p-[4-[p-[[(2R,4S)-rel-2-(2,4-dichlorophenyl)-2-(1H-1,2,4-triazol-1­-ylmethyl)-1,3-dioxolan-4-yl]methoxy]phenyl]-1-piperazinyl]phenyl]-Δ²-1,2,4-triazolin-5-one. Please check it out. --vaccinationist (T) 11:37, 26 August 2016 (UTC)

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