Drawbacks

Pulse itraconazole therapy is approved for fingernail, but not toenail, onychomycosis in the US. Adverse events occur with a low frequency and are generally mild to moderate in severity and are reversible. These events include gastrointestinal upset, cutaneous eruption and headache.185 Studies report a low discontinuation rate because of adverse events. Itraconazole may interact with several drugs, some of which are contraindicated with this triazole.155,173,174,186 In some cases the drug interaction may be explained by inhibition of cytochrome P450 CYP3A4 by itraconazole. Itraconazole is contraindicated in North America (USA and Canada) in patients with evidence of ventricular dysfunction, for example, congestive heart failure or a history of heart failure.155,187 Hepatic enzymes should be monitored in patients with pre-existing hepatic function abnormalities or those who have experienced liver toxicity with other medications. Hepatic enzymes should be monitored periodically in all patients receiving continuous treatment for more than 1 month, or at any time a patient develops signs or symptoms suggestive of liver dysfunction.155,187

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