Canditral (Itraconazole)
Also sold as: Canditral, Sporanox, Itaspor, Fungimap, Itraspor
Pregnancy
Cat C
Lactation
Avoid
Schedule
H
Forms
Capsule 100mg +2
Indications
- Dermatophytosis (tinea corporis, tinea cruris, tinea pedis) — oral for widespread/nail disease
- Onychomycosis (fungal nail infection) — pulse or continuous therapy
- Vaginal candidiasis (recurrent)
- Oropharyngeal/oesophageal candidiasis (especially in HIV)
- Aspergillosis (invasive — second-line after voriconazole)
- Histoplasmosis, blastomycosis, sporotrichosis
- Pityriasis versicolor (recalcitrant cases)
Adult Dosing
Tinea corporis/cruris
100 mg PO once daily for 15 days OR 200 mg once daily for 7 days
Take with food (capsule — fat meal enhances absorption); empty stomach for solution
Onychomycosis (fingernails) — pulse
200 mg BD for 7 days, repeat after 3 weeks rest (2 pulses for fingernails, 3 for toenails)
Pulse therapy — more cost-effective, similar efficacy
Onychomycosis — continuous
200 mg PO once daily for 12 weeks (toenails) or 6 weeks (fingernails)
Vaginal candidiasis (recurrent prophylaxis)
200 mg BD on day 1, then 200 mg once daily for 3 days — or 200 mg once monthly for 6 months (prophylaxis)
Aspergillosis
200 mg BD
Specialist guided; duration varies
Pediatric Dosing
Paediatric dosing for invasive fungal infection: specialist supervised
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 30 mL/min | IV form CONTRAINDICATED (cyclodextrin accumulation). Oral: use with caution; no specific adjustment but monitor. |
Hepatic Adjustment
Use with extreme caution in hepatic disease — risk of drug accumulation and hepatotoxicity. Check LFTs before starting and monitor.
Pregnancy & Lactation
Pregnancy: Category C
AVOID unless essential — animal studies show teratogenicity. If used in reproductive-age women, ensure effective contraception during and for 2 months after treatment. Avoid systemic itraconazole in 1st trimester; topical azoles preferred for vaginal candidiasis in pregnancy.
Lactation: Avoid
Excreted in breast milk — avoid systemic use. Use topical antifungals for superficial infections during breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Statins (simvastatin, lovastatin, atorvastatin) | CONTRAINDICATED with simvastatin/lovastatin — myopathy/rhabdomyolysis. Avoid/reduce atorvastatin. Rosuvastatin and pravastatin less affected. | Major |
| Benzodiazepines (midazolam, triazolam — oral) | CONTRAINDICATED — excessive sedation and respiratory depression | Major |
| QT-prolonging drugs (terfenadine, cisapride, quinidine, pimozide, ivabradine) | Severe QT prolongation/torsades de pointes — contraindicated | Major |
| Rifampicin, phenytoin, carbamazepine | CYP3A4 inducers — dramatically reduce itraconazole levels; avoid combination | Major |
| Digoxin | Itraconazole raises digoxin levels — toxicity risk | Major |
| Warfarin | INR rises significantly — reduce warfarin dose and monitor INR frequently | Major |
| Ciclosporin, tacrolimus | Elevated immunosuppressant levels — toxicity and nephrotoxicity risk | Major |
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Side Effects
Common
- Nausea and vomiting
- Abdominal discomfort
- Headache
- Dizziness
- Rash
- Hypokalaemia
Serious / Discontinue If
- Hepatotoxicity (rare but serious — check LFTs; stop if symptomatic)
- Heart failure (negative inotropic effect — AVOID in ventricular dysfunction)
- Severe drug interactions (statins, benzodiazepines, QT drugs)
- Stevens-Johnson syndrome (rare)
- Peripheral neuropathy (long-term)
Contraindications
- Ventricular dysfunction / heart failure
- Concurrent terfenadine, astemizole, cisapride, oral midazolam, quinidine, pimozide, lovastatin, simvastatin
- Concurrent rifampicin (if unable to avoid)
- Pregnancy (unless life-threatening fungal infection)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Canditral 100mg | Glenmark | 14 cap ₹275 |
| Canditral 200mg | Glenmark | 14 cap ₹425 |
| Itaspor 100mg | Cipla | 14 cap ₹255 |
| Fungimap 200mg | Sun Pharma | 14 cap ₹395 |
Monitoring Required
- LFTs at baseline and if symptoms develop (routine monitoring not mandatory for short courses)
- Drug interactions (comprehensive check before prescribing)
- INR if on warfarin
- Clinical response (nail cultures at 3–6 months)
- Potassium levels
Patient Counseling Points
- Take capsule immediately after a full fat meal — absorption is much better with food (solution: take fasted)
- Do not take with antacids — reduces absorption
- Complete the full course even if nails/skin look better
- Report yellow eyes/skin, dark urine, or persistent nausea — may indicate liver problem
- Do not take with simvastatin/lovastatin cholesterol tablets — dangerous muscle damage
- Women: use reliable contraception during and 2 months after treatment
- Do not take with grapefruit juice — affects drug levels
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Clinically reviewed by: Dr. Padmavathi Rao, MD (Dermatology), Senior Consultant Dermatologist
Last reviewed: 2026-04-01
References
- BNF — Itraconazole
- IDSA Candidiasis Guidelines 2016
- ESCMID Onychomycosis Guidelines
- Indian Dermatology Online Journal — Antifungals