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Candida - female genital - Management
Oral itraconazole

  • The most common adverse effects associated with itraconazole are dyspepsia, abdominal pain, nausea, and constipation.
  • There have been rare reports of liver toxicity.
    • Advise the person to seek immediate medical attention if symptoms of possible liver toxicity develop, such as anorexia, vomiting, fatigue, abdominal pain, or dark urine [BNF 53, 2007].
  • Avoid itraconazole in the following people:
    • People with raised liver enzymes or active liver disease, or people who have a history of developing liver toxicity with other drugs, unless the benefits outweigh the risks.
    • People with heart failure or a history of heart failure, unless the benefits outweigh the risks, as itraconazole has been shown to have a negative inotropic effect [ABPI Medicines Compendium, 2007].
    • People taking astemizole, pimozide, quinidine or terfenadine, because there is a risk of cardiac arrhythmias.
    • People taking a statin, as the risk of myopathy is increased [ABPI Medicines Compendium, 2007].
  • As a result of rare reports of heart failure, the Committee on the Safety of Medicines (CSM) has advised caution when prescribing itraconazole to patients at high risk of heart failure [CSM, 2001], including:
    • People receiving high doses and longer treatment courses.
    • Older people and those with cardiac disease.
    • People taking negative inotropic drugs (e.g. calcium-channel blockers).
  • Baseline liver function tests (LFTs) may be considered for people taking short courses of itraconazole. LFTs should be checked if anorexia, jaundice, nausea, vomiting, fatigue, or abdominal pain occur, or if the urine becomes dark during treatment.
Clarification / Additional information
  • There is anecdotal evidence that oral itraconazole may cause oral contraceptive failure, however the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), do not consider additional contraceptive precautions necessary when taking itraconazole [FFPRHC, 2005].

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