Itraconazole Dosage for Fungal Infections

Dosing by Infection Type

For fluconazole-refractory esophageal disease, itraconazole solution 200 mg once daily for up to 28 days is recommended by the Infectious Diseases Society of America 1
For mild to moderate pulmonary blastomycosis, itraconazole 200 mg once or twice daily for 6-12 months is suggested by the Infectious Diseases Society of America 2, 3
For moderately severe to severe pulmonary disease, initial therapy with amphotericin B for 1-2 weeks, followed by itraconazole 200 mg three times daily for 3 days, then 200 mg twice daily for a total of 6-12 months is recommended by the Infectious Diseases Society of America 4, 5
For mild to moderate disseminated disease, itraconazole 200 mg once or twice daily for 6-12 months is suggested by the Infectious Diseases Society of America 2, 3
For osteoarticular blastomycosis, total treatment duration of at least 12 months is recommended by the Infectious Diseases Society of America 2, 3

Itraconazole capsules should be taken with food to enhance absorption, as recommended by the Infectious Diseases Society of America 6
Serum levels of itraconazole should be determined after at least 2 weeks of therapy to ensure adequate drug exposure, as suggested by the Infectious Diseases Society of America 4, 5, 7
Significant drug-drug interactions occur due to cytochrome P450 inhibition, as noted by the Infectious Diseases Society of America 6

For systemic infections, 6-12 months for blastomycosis is recommended by the Infectious Diseases Society of America 4, 5
For CNS infections, at least 12 months and until resolution of CSF abnormalities is suggested by the Infectious Diseases Society of America 7
Immunosuppressed patients may require lifelong suppressive therapy if immunosuppression cannot be reversed, as recommended by the Infectious Diseases Society of America 2

The Infectious Diseases Society of America recommends itraconazole 200 mg twice daily as the standard dose for most systemic fungal infections in adults with normal renal function, with a loading dose of 200 mg three times daily for 3 days recommended for severe infections 8
For moderately severe to severe blastomycosis, the American College of Physicians suggests starting with amphotericin B for 1-2 weeks, then itraconazole 200 mg three times daily for 3 days (loading), followed by 200 mg twice daily to complete 6-12 months total 8
The Infectious Diseases Society of America recommends itraconazole 200 mg twice daily orally as an alternative therapy for non-meningeal cryptococcosis, used primarily when fluconazole is not appropriate or available 9

The American Academy of Pediatrics recommends itraconazole 10 mg/kg per day (maximum 400 mg daily) for children with blastomycosis 8
The Infectious Diseases Society of America suggests lifelong suppressive therapy with itraconazole 200 mg daily may be required for immunosuppressed patients if immunosuppression cannot be reversed 8