Candidiasis of the mucous membrane trenbolone enanthate dosage of the mouth, keratomikoz; onychomycosis caused by dermatophytes or yeasts; systemic mycoses – systemic aspergillosis and candidiasis, cryptococcosis (including cryptococcal meningitis) in immunokompromitirovannyh persons and cryptococcosis of the central nervous system, regardless of the immune status at treatment failure 1st line; histoplasmosis, blastomycosis, sporotrichosis, paracoccidioidomycosis; Other rare system and tropical mycoses.
Kidney and trenbolone enanthate dosage liver failure, peripheral neuropathy, risk factors: Chronic heart failure (ischemic heart disease, damage to the heart valves, severe pulmonary disease, including chronic obstructive pulmonary disease, a condition accompanied by edema syndrome), hearing loss, simultaneous receiving blockers of slow calcium channels, children and old age.
Dosing and Administration
Inside. Immediately after a meal. Capsules are swallowed whole.
Elimination of the drug itraconazole from skin trenbolone enanthate dosage and nail tissue is slower than from plasma. Thus, the optimal clinical and mycological effects are reached 2-4 weeks after the end of treatment for skin infections and 6-9 months after the end of treatment of nail infections.
The duration of treatment may be adjusted depending on the clinical picture of treatment:
Side effects: the part of the trenbolone enanthate dosage gastrointestinal tract: dyspepsia (nausea, vomiting, diarrhea, constipation, loss of appetite), abdominal pain. From the hepato-biliary system: a reversible increase in “liver” enzymes, hepatitis and in very rare cases, itraconazole develop severe hepatotoxicity, including cases of acute liver failure with fatal consequences. from the nervous system: headache, dizziness, peripheral neuropathy. immune system: anaphylactic, anafilaktoidiye and allergic reactions. For the skin: a very rare cases – exudative erythema multiforme (Stevens-Johnson syndrome), skin rash, pruritus, urticaria, angioedema, alopecia, photosensitivity. Other: menstrual disorders, hypokalemia, edema syndrome, chronic heart failure and pulmonary edema.
No data. In case of accidental overdose, supportive measures should be used. As to gastric lavage and, if necessary, to assign the activated carbon within the first hour. Itraconazole not appear in hemodialysis. Any specific antidote does not exist.
Interactions with other drugs
- Drugs affecting the absorption of itraconazole Drugs that reduce gastric acidity, reduce the absorption of itraconazole, which is related to the solubility of the capsule shell.
- Drugs affecting the metabolism of itraconazole. Itraconazole is mainly metabolized by isoenzyme CYP3A4. the interaction of itraconazole has been investigated with rifampicin, rifabutin and phenytoin, which are potent inducers of CYP3A4 isoenzyme. The study found that, in these cases, the bioavailability of itraconazole and gidroksiitrakonazola significantly reduced, which leads to a substantial reduction efficacy. Concomitant use of itraconazole with these drugs, which are potential inducers of microsomal liver enzymes is not recommended. Studies of interaction with other inducers of hepatic microsomal enzymes such as carbamazepine, phenobarbital and isoniazid were not conducted, however, similar results can be expected. Potent inhibitors isoenzyme CYP3A4, such as ritonavir, indinavir, clarithromycin and erythromycin, can increase the bioavailability of itraconazole.
- Effect of itraconazole on the metabolism of other drugs. Itraconazole can inhibit the metabolism of drugs, cleavable isoenzyme CYP3A4. The result may be increased or prolonging their action, including side effects. Before taking concomitant medications, you should consult with your doctor about the metabolic pathways of the drug specified in the instruction on medical trenbolone enanthate dosage application. After the cessation of treatment in the plasma concentration of itraconazole is gradually reduced depending on the dose and duration of treatment (see. Section Pharmacokinetics ). This should be taken into account in the discussion of the floating effect of itraconazole on concomitant medications.
Examples of these medications include:
Drugs that should not be administered concurrently with itraconazole:
- Terfenadine, astemizole, mizolastine, cisapride, dofetilide, quinidine, pimozide, levacetylmethadol, sertindole – the combined use of these drugs with itraconazole can cause increase in the concentration of these substances in plasma and increase the risk of QT prolongation, and in rare cases -vozniknovenie atrial ventricular arrhythmia (torsade de pointes).
- metabolized by CYP3A4 isoenzyme inhibitors CoA reductase GMG such as simvastatin and lovastatin,
- midazolam and oral triazolam,
- ergot alkaloids such as dihydroergotamine, ergometrine, ergotamine and metilergometrin,
- Blockers “slow” calcium channels – in addition to possible pharmacokinetic interactions associated with common pathway of metabolism with the participation of CYP3A4 isoenzyme, blockers “slow” calcium channel blockers can have negative inotropic effect, which is enhanced by concomitantly with itraconazole.
Formulations in which assignment must monitor their concentrations in plasma, by the action, side effects. In the case of co-administration with itraconazole dose of these preparations, if necessary, should be reduced.
- Indirect anticoagulants;
- HIV protease inhibitors such as ritonavir, indinavir, saquinavir;
- Some anti-cancer drugs such as vinca alkaloids, busulfan, docetaxel, trimetrexate;
- metabolized by CYP3A4 isoenzyme blockers “slow” calcium channel blockers, such as verapamil and derivatives of dihydropyridine;
- Some immunosuppressive agents: cyclosporine, tacrolimus, sirolimus (also known as rapamycin);
- Some metabolized isoenzyme CYP3A4 inhibitors CoA reductase GMG such as atorvastatin;
- Some glucocorticosteroids such as budesonide, dexamethasone, and methylprednisolone;
- Other drugs: digoxin, carbamazepine, buspirone alfentanil, alprazolam, brotizolam, midazolam intravenous, rifabutin, ebastine, reboxetine, cilostazol, dizoliramid, eletriptan, halofantrine, repaglinide.
The interactions between itraconazole and zidovudine and fluvastatin were found.
There was no effect of itraconazole on the metabolism of ethinyl estradiol and norethisterone.
- The effect on the plasma protein bond.
in vitro studies demonstrated no interaction between itraconazole and other drugs such as imipramine, propranolol, diazepam, cimetidine, indometacin, tolbutamide and sulfamethazine upon binding to plasma proteins.
- Women of childbearing potential taking Itraconazole, you must use reliable methods of contraception throughout the course of treatment until the onset of the first menstrual period after its completion.
- It found that itraconazole has a negative inotropic effect. At the same time taking itraconazole and calcium channel blockers, which may have the same effect, you must be careful. It reported cases of congestive heart failure associated with the reception of itraconazole. Itraconazole should not be taken in patients with chronic heart failure, or with the presence of this disease in history except in cases where the potential benefit significantly outweighs the potential risk. When an individual assessment of the ratio of benefits and risks should be taken into account such factors as the seriousness of the indications, dosage regimen and individual risk factors for congestive heart failure. Risk factors include the presence of heart disease, such as coronary heart disease or valvular disease; serious lung diseases, such as obstructive lung disease; kidney failure and other diseases, accompanied by edema. Such patients should be informed about the signs and symptoms of congestive heart failure.Treatment should be given with caution, and the patient should be monitored for the onset of symptoms of congestive heart failure. When they appear receiving itraconazole should be discontinued.
- At low acidity of the stomach: in this condition the absorption of itraconazole capsules violated. Patients taking antacids (e.g., aluminum hydroxide), it is recommended to use them not earlier than 2 hours after administration of itraconazole capsules. Patients with achlorhydria or applying blockers H 2 histamine receptors, and proton pump inhibitors, are advised to take itraconazole capsules with drinks containing cola.
- In very rare cases, itraconazole develop severe hepatotoxicity, including cases of acute liver failure with fatal consequences. In most cases it is observed in patients who already had liver disease, patients with other serious illnesses treated by systemic itraconazole therapy indications, as well as patients who received other drugs having hepatotoxic. Some patients have no obvious risk factors identified in relation to liver damage. Several of these cases occurred in the first month of therapy, and some – in the first week of treatment. In this connection, it is recommended to regularly monitor liver function in patients receiving treatment with itraconazole. Patients should be warned of the need to immediately contact your doctor in case of symptoms, suggesting the occurrence of hepatitis, such as: anorexia, nausea, vomiting, weakness, abdominal pain, and dark urine. In the case of the appearance of these symptoms should immediately discontinue therapy and to conduct a study of liver function.Patients with a higher concentration of “liver” enzymes or liver disease in the active phase, or at any adjourned toxic liver damage when taking other medications should not be given itraconazole treatment unless the expected benefit justifies the risk of liver damage. In these cases, during the treatment to monitor the concentration of “liver” enzymes.
- Abnormal liver function: itraconazole is metabolized primarily in the liver. Since patients with impaired hepatic function a full half-life of itraconazole increased slightly, it is recommended to carry out monitoring of itraconazole concentration in plasma and adjust the dose if necessary.
- Renal function: As patients with complete renal failure the half-life of itraconazole increased slightly, it is recommended to monitor the concentration of itraconazole in plasma and adjust the dose if necessary.
- Patients with immunodeficiency: the bioavailability of itraconazole when given orally can be reduced in some patients with impaired immunity, for example, in neutropenic patients, patients with AIDS or undergoing organ transplants.
- Patients with systemic fungal infections that threaten life as a result of the pharmacokinetic characteristics of Itraconazole capsules are not recommended to start treatment of systemic fungal infections that threaten patients’ lives.
- AIDS patients.
- The attending physician should evaluate the need for the appointment of maintenance therapy to AIDS patients who have received prior treatment for systemic fungal infections such as sporotrichosis, blastomycosis, histoplasmosis or cryptococcosis (meningeal how and nemeningealnogo), in which there is a risk of recurrence.
- Clinical data on the use of Itraconazole capsules in pediatric patients is limited. Itraconazole capsules should not be administered to children, except in cases where the expected benefits outweigh the potential risk.
- The treatment should be discontinued when a peripheral neuropathy that might be associated with the reception of itraconazole capsules.
- There is no evidence of cross-hypersensitivity to itraconazole and other azole antifungal agents.
Effects on ability to drive and operate machinery
Itraconazole can cause dizziness and other side effects, which may affect the ability to drive vehicles and other machinery requiring attention during operation.
capsules 100 mg.
In 1,3,4,5,6 or 7 capsules in blisters.
In 1,2,3,4 or 5 contour cell package together with instructions for use in a pile of cardboard.
In a dry, dark place at a temperature no higher than 25 ° C. Keep out of the reach of children.
3 years. Do not use beyond the expiration date printed on the package.