이트라코나졸
Itraconazole
다른 이름: Sporanox · Intrafungol · Itrafungol · itraconazolum · oriconazole · R-51211
VetSheet 수의사 팀 검수업데이트 2026년 5월 15일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Malassezia dermatitis | 5 mg/kg PO once daily | PO | q24h | 3 weeks | 🌎 NA |
| Pulse therapy for Malassezia dermatitis | 5 mg/kg for 2 consecutive days per week | PO | 2 consecutive days per week | 3 weeks | 🌎 NA |
| Dermatophytosis | 5 mg/kg PO once daily | PO | q24h | Prolonged course required | 🌎 NA |
| Dermatophytosis (Pulse therapy) | 5 mg/kg PO once daily on an every other week schedule | PO | q24h (pulse) | Three 'pulses' of one week on, one week off | 🌎 NA |
| Blastomycosis | 5 mg/kg PO once daily | PO | q24h | At least 30 days after all signs resolve (total 60-90 days) | 🌎 NA |
| Histoplasmosis | 10 mg/kg daily PO | PO | q24h | At least 30 days after all signs resolve (total at least 90 days) | 🌎 NA |
| Blastomycosis (Alternative) | 5 mg/kg PO once a day or divided twice a day | PO | q24h or q12h | 2-3 months or until active disease is not apparent | 🌎 NA |
| Coccidiomycosis | 5-10 mg/kg PO once daily | PO | q24h | 6-12 months | 🌎 NA |
| Sporotrichosis | 5-10 mg/kg once daily | PO | q24h | 30 days beyond complete resolution of detectable lesions | 🌎 NA |
| Pythiosis or lagendiosis (after lesion resection) | 10 mg/kg PO once daily | PO | q24h | At least 2 months after surgery | 🌎 NA |
| Zygomycosis | 5-10 mg/kg PO q24h | PO | q24h | 3-6 months for non-resectable lesions | 🌎 NA |
| Idiopathic lymphoplasmacytic (chronic) rhinitis (LPR) | 5 mg/kg PO q12h | PO | q12h | Minimum of 3-6 months | 🌎 NA |
| Nasal aspergillosis | 5 mg/kg PO q12h | PO | q12h | 3-6 months | 🌎 NA |
| Coccidioidomycosis | 5-10 mg/kg PO q24h or 5 mg/kg PO q12h | PO | q24h or q12h | — | 🌎 NA |
| General use (fungal infections) | 5 mg/kg | PO | q24h | 4-20 weeks of treatment may be needed, dependent upon culture results | 🌍 EU |
- Malassezia dermatitis: Fair evidence supports recommendation
- Dermatophytosis: Begin taking cultures after 4 weeks. Continue therapy for 2 weeks beyond clinical cure and when 2-3 negative cultures are obtained at weekly intervals.
- Dermatophytosis (Pulse therapy): Toxicity problems are rare with this protocol.
- Blastomycosis: Give with food.
- Histoplasmosis: Give with food. If intestinal histoplasmosis, treat with amphotericin B initially.
- Blastomycosis (Alternative): A loading dose of 10 mg/kg once a day (or divided twice a day) for the first three days may reduce the 'lag' phase.
- Pythiosis or lagendiosis (after lesion resection): Given with terbinafine at 5-10 mg/kg PO q24h.
- Zygomycosis: After aggressive surgical resection or for non-resectable lesions.
- Idiopathic lymphoplasmacytic (chronic) rhinitis (LPR): Has shown dramatic beneficial improvement in some dogs.
- Nasal aspergillosis: May cure up to 60-70% of dogs, although some studies show marginal efficacy.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Histoplasmosis | 10 mg/kg daily PO | PO | q24h | At least 2-4 months | 🌎 NA |
| Cryptococcosis | 50-100 mg per cat per day PO | PO | q24h | Many months (mean 8.5 months) | 🌎 NA |
| Blastomycosis | 10 mg/kg PO once a day or divided twice a day | PO | q24h or q12h | 2-3 months or until active disease is not apparent | 🌎 NA |
| Coccidiomycosis | 5-10 mg/kg PO once daily | PO | q24h | 6-12 months | 🌎 NA |
| Sporotrichosis | 5-10 mg/kg once daily | PO | q24h | 30 days beyond complete resolution of detectable lesions | 🌎 NA |
| Cryptococcosis (mild to moderate, no CNS involvement) | Cats <= 3.5 kg: 50 mg PO once daily or 100 mg PO every other day; Medium/large cats: 100 mg PO once daily | PO | q24h or q48h | 3-12 months | 🌎 NA |
| Coccidioidomycosis | 25-50 mg (total dose) per cat q12-24h | PO | q12-24h | — | 🌎 NA |
| Generalized dermatophytosis (Microsporum canis) | 5 mg/kg PO once daily preferably between meals for 7 days on, 7 days off; repeat 3 times | PO | q24h (pulse) | 5 weeks (treated weeks 1, 3, 5) | 🌎 NA |
| Generalized dermatophytosis (Alternative) | 5 mg/kg PO twice daily or 10 mg/kg | PO | q12h or q24h | Generally 3-5 weeks | 🌎 NA |
| Dermatophyte granuloma | 10 mg/kg PO once daily | PO | q24h | Weeks to months | 🌎 NA |
| Dermatophytosis (Pulse therapy) | 5 mg/kg PO once daily on an every other week schedule | PO | q24h (pulse) | Three 'pulses' of one week on, one week off | 🌎 NA |
| General use (fungal infections) | 5 mg/kg | PO | q24h | 4-20 weeks of treatment may be needed, dependent upon culture results | 🌍 EU |
| Dermatophytosis (Microsporum canis) | 5 mg/kg | PO | q24h | Pulse dosing: 7 days on, 7 days off repeated x3 | 🌍 EU |
- Histoplasmosis: Given with food. Can also be divided twice daily.
- Cryptococcosis: If response inadequate, may add flucytosine.
- Blastomycosis: Cats usually require longer treatment than dogs.
- Cryptococcosis (mild to moderate, no CNS involvement): Give with food. Monitor ALT. Continue until completely normal, then check antigen titer.
- Generalized dermatophytosis (Alternative): Give with food. Give until culture is negative 2 times at two week intervals.
- Dermatophyte granuloma: At least one month beyond clinical resolution and until brush culture is negative x 2.
- Dermatophytosis (Microsporum canis): Authorized in the form of an oral solution. Used successfully to treat ringworm in Persian cats without the need for clipping.
소형 포유류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Blastomycosis (Mice) | 50-150 mg/kg q24h | PO | q24h | — | 🌎 NA |
| Vaginal candidiasis (Rats) | 2.5-10 mg/kg q24h | PO | q24h | — | 🌎 NA |
| Systemic candidiasis (Guinea pigs) | 5 mg/kg q24h | PO | q24h | — | 🌎 NA |
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Fungal infections in Ratites | 6-10 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| Fungal diseases | 5-10 mg/kg PO q12-24h | PO | q12-24h | — | 🌎 NA |
| Aspergillosis (Amazon parrots) | 5-10 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| Aspergillosis (African grey Parrots) | 2.5-5 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
- Fungal infections in Ratites: If neuro signs develop reduce dose or discontinue.
- Fungal diseases: Use with caution in African grey parrots.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Guttural pouch mycosis, mycotic rhinitis or osteomyelitis | 5 mg/kg PO q24h | PO | q24h | — | 🌎 NA |
- Guttural pouch mycosis, mycotic rhinitis or osteomyelitis: Using the oral solution should be sufficient for treatment.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
이트라코나졸은 합성된 고친유성 경구용 트리아졸계 항진균제로, 수의학에서 전신성 진균증(아스페르길루스증, 크립토코쿠스증, 분아균증, 히스토플라스마증 등) 및 표재성 피부사상균증과 말라세지아 감염 치료에 널리 사용됩니다.
임상적 진주 및 약리학적 프로파일:
- 우수한 효능: 케토코나졸과 같은 구형 이미다졸계보다 효능이 더 뛰어나며, 포유류의 호르몬 합성을 크게 억제하지 않아 내분비계 부작용이 적습니다.
- 조직 분포: 친유성 및 친각질성이 매우 높아 피부, 피지, 농에 고농도로 축적되므로 피부 진균 감염에 탁월한 효과를 보입니다.
- 제형의 중요성: 이트라코나졸의 흡수는 제형에 크게 의존합니다. 시판되는 캡슐제는 최적의 흡수를 위해 산성 위 환경과 음식물이 필요합니다. 시판 경구용 액제는 용해도를 높이기 위해 시클로덱스트린을 함유하고 있으며 공복 상태에서 가장 잘 흡수됩니다.
- 조제 경고: 벌크 분말을 이용한 임의 조제(Compounding)는 강력히 권장하지 않습니다. 이는 종종 혈중 농도를 치료 수준 이하로 떨어뜨리거나 측정 불가능하게 만들어 전신성 진균 감염 시 치명적일 수 있습니다.
작용 기전
Itraconazole is a fungistatic triazole.
Mechanism of Action:
- Enzyme Inhibition: Itraconazole selectively inhibits the fungal cytochrome P450-dependent enzyme lanosterol 14α-demethylase.
- Pathway Disruption: This inhibition blocks the conversion of lanosterol to ergosterol (the primary sterol in fungal cell membranes) → leads to the accumulation of toxic 14α-methylsterols.
- Membrane Permeability: The lack of ergosterol alters the cellular membrane structure → increases membrane permeability → allows leakage of cellular contents and impairs the uptake of purine and pyrimidine precursors.
- Immunomodulation: Itraconazole also exhibits mild immune-suppressing activity, likely via the suppression of T-lymphocyte proliferation.
안전성·주의사항
금기사항
- Hypersensitivity to itraconazole or other azole antifungals
- Hepatic impairment (relative contraindication)
- Achlorhydria or hypochlorhydria (relative contraindication)
- Reduced cardiac function (relative, due to potential negative inotropic effects)
- Pregnancy
- Liver disease (avoid use if present)
부작용
- Anorexia (most common in dogs)
- Hepatotoxicity (increased ALT, jaundice)
- Ulcerative skin lesions/vasculitis (dogs at high doses)
- Limb edema (dogs at high doses)
- Erythema multiforme (rare)
- Toxic epidermal necrolysis (rare)
- Vomiting
- Weight loss
- Depression (especially in cats and African grey parrots)
- Diarrhoea
- Salivation
- Depression and apathy
- Abdominal pain
- Hepatic toxicosis
- Ulcerative dermatitis
- Limb oedema
- Serious cutaneous drug eruptions (occasional)
- Dose-related suppression of adrenal function
주의
Use with caution in patients with hepatic impairment, achlorhydria, or reduced cardiac function (due to potential negative inotropic effects). African grey parrots are extremely sensitive to itraconazole and can develop severe anorexia and depression; reduced dosages or alternative antifungals are recommended. Do not use compounded capsules from bulk powders, as they may not yield an absorbable dosage form, leading to treatment failure in life-threatening infections. Safety during pregnancy is not established (teratogenic and embryotoxic in lab animals at high doses).
약물 상호작용
May be antagonistic against Aspergillus or Candida; clinical importance unclear.
May reduce oral absorption of itraconazole; administer itraconazole at least 1 hour before or 2 hours after antacids.
Itraconazole may increase benzodiazepine levels.
Plasma concentrations may be elevated.
Itraconazole may increase levels.
Itraconazole may increase levels.
Increased cisapride levels and possibility for toxicity; concurrent use contraindicated in humans.
May decrease metabolism and increase clomipramine levels.
May inhibit the metabolism of corticosteroids; potential for increased adverse effects.
May inhibit metabolism of cyclophosphamide and its metabolites; potential for increased toxicity.
Increased cyclosporine levels.
May increase digoxin levels; concurrent use considered contraindicated in humans.
May increase fentanyl or alfentanil levels.
Increased gastric pH may reduce itraconazole absorption.
May increase risk for neurotoxicity.
May increase itraconazole concentrations.
May decrease itraconazole levels.
Increased gastric pH may reduce itraconazole absorption.
Increased risk for quinidine toxicity.
May decrease itraconazole levels; itraconazole may increase rifampin levels.
May increase levels; hypoglycemia possible.
May inhibit vinca alkaloid metabolism and increase levels.
May cause increased prothrombin times in patients receiving warfarin or other coumarin anticoagulants.
Extends the activity of methylprednisolone
Inhibits metabolism, potentially leading to toxicity
Inhibits metabolism
Inhibits metabolism
Increases bioavailability and blood levels of ciclosporin (well-documented in cats)
Inhibits metabolism and increases plasma concentrations
Reduces the absorption of itraconazole
Reduces the absorption of itraconazole
Reduces the absorption of itraconazole
Increases plasma concentrations of benzodiazepines
Increases plasma concentrations of vincristine
Datasheet advises against concurrent administration in cats
Datasheet advises against concurrent administration in cats
모니터링
- Clinical Efficacy
- Liver function tests (monthly ALT recommended with long-term therapy)
- Appetite (anorexia is often the first sign of toxicity)
- Physical assessment for ulcerative skin lesions in dogs
- Liver enzymes (ALT, AST, ALP, Bilirubin) prior to and during prolonged treatment
- Clinical signs of hepatotoxicity (anorexia, vomiting, jaundice)
- Resolution of clinical signs and negative fungal cultures
약동학
흡수
Highly dependent on gastric pH and presence of food. Empty stomach bioavailability may be <50%; with food, it approaches 100%. The oral solution is better absorbed on an empty stomach and possesses adequate bioavailability. Compounded capsules from bulk powders may not be absorbed.
분포
Very high protein binding. Widely distributed to lipid-rich tissues (highly lipophilic). Skin, sebum, female reproductive tract, and pus have concentrations greater than serum. Minimal concentrations in CSF, urine, aqueous humor, and saliva.
대사
Metabolized by the liver to many different metabolites, including the active metabolite hydroxyitraconazole.
배설
Elimination may be a saturable process. Because of its long half-life, steady-state plasma levels are not reached for at least 6 days without a loading dose.
과다투여
There is very limited information on acute toxicity.
- Decontamination: Giving oral antacids may help reduce absorption. If a large overdose occurs, consider gut emptying and provide supportive therapy.
- Clearance: Itraconazole is not removed by dialysis.
- Chronic Toxicity: In studies, dogs receiving 40 mg/kg PO daily for 3 months demonstrated no overt toxicity.
제품
제형
- Capsules
- 100 mg capsule
- 10 mg/ml oral solution
동물용의약품
- Intrafungol® (Janssen) oral liquid 10 mg/mL (Available in UK/select countries)
- Itrafungol 10 mg/ml oral solution
인용의약품
- Sporanox® Capsules 100 mg (and generics)
- Sporanox® Oral Solution 10 mg/mL
- Sporanox 100 mg capsule
규제 현황
POM-V
POM-V, POM
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Capsules should be stored between 15-25°C and protected from light and moisture. Oral solution should be stored at temperatures less than 26°C, and protected from freezing.
보호자 정보
중요 투여 지침:
- 캡슐제: 적절한 흡수를 위해 반드시 음식과 함께 투여해야 합니다. 고양이와 소형견의 경우 캡슐을 열어 알갱이를 소량의 맛있는 음식(예: 버터, 치즈, 통조림 사료)에 섞어 줄 수 있습니다.
- 경구용 액제: 포유류의 경우 이상적으로 공복 상태에서 투여해야 합니다.
주의 깊게 살펴볼 사항:
- 식욕 부진은 약물이 간에 영향을 미치고 있다는 첫 번째 징후인 경우가 많습니다. 반려동물이 먹이를 거부하거나, 구토를 시작하거나, 눈/잇몸이 노랗게 변하는 것(황달)을 발견하면 즉시 수의사에게 연락하십시오.
- 개의 경우 원인을 알 수 없는 피부 궤양이나 다리 부종이 있는지 관찰하십시오.
안전 경고:
- 벌크 분말로 조제된 약물은 사용하지 마십시오. 흡수율이 매우 떨어져 치료 실패로 이어질 수 있으며, 이는 심각한 진균 감염에 있어 매우 위험합니다.
- 수의사의 승인 없이 다른 약물(특히 제산제)과 함께 투여하지 마십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.