Itraconazole exerts its antifungal activity by inhibiting cytochrome P450–dependent enzymes, thereby blocking the synthesis of ergosterol, an essential component of fungal cell membranes. Disruption of ergosterol production leads to altered membrane permeability, impaired enzyme function, abnormal cell wall formation, and accumulation of intracellular lipids, ultimately inhibiting fungal growth and viability.
Nocandia utilizes SUBA (Super Bio-Available) technology, which enhances the oral bioavailability of itraconazole. This technology employs a solid dispersion of the drug within a polymer matrix, significantly improving dissolution and absorption compared to conventional crystalline formulations. As a result, SUBA itraconazole demonstrates a broad antifungal spectrum and improved pharmacokinetic profile.
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Nocandia is indicated for the treatment of a wide range of superficial and systemic fungal infections, including:
It is also used in serious systemic fungal infections such as candidiasis, aspergillosis, and cryptococcosis (including cryptococcal meningitis). Additionally, Nocandia is prescribed for maintenance therapy in AIDS patients to prevent relapse of fungal infections and for prophylaxis during prolonged neutropenia.
Antifungal agents for systemic and superficial mycoses
Non-systemic fungal infections
Vulvovaginal candidiasis: 200 mg twice daily for 1 day
Pityriasis versicolor: 200 mg once daily for 7 days
Tinea corporis / tinea cruris:
100 mg once daily for 15 days or
200 mg once daily for 7 days
Tinea pedis / tinea manuum: 100 mg once daily for 30 days
Oropharyngeal candidiasis:
100 mg once daily for 15 days
Increase to 200 mg once daily for 15 days in AIDS or neutropenic patients
Onychomycosis:
Continuous therapy: 200 mg daily for 3 months, or
Pulse therapy: 200 mg twice daily for 7 days, repeated every 21 days
Fingernails: 2 courses
Toenails: 3 courses
Aspergillosis: 200 mg once daily for 2–5 months; increase to 200 mg twice daily in invasive disease
Candidiasis: 100–200 mg once daily for 3 weeks to 7 months; increase dose if invasive
Non-meningeal cryptococcosis: 200 mg once daily for 10 weeks
Cryptococcal meningitis: 200 mg twice daily for 2–6 months
Histoplasmosis: 200 mg once or twice daily for 8 months
Maintenance in AIDS: 200 mg once daily until immune recovery
Neutropenia prophylaxis: 200 mg once daily until immune recovery
Dosing follows the same clinical indications as above, with adjusted strengths:
Non-systemic infections: 65–130 mg once or twice daily, depending on condition
Systemic infections: Dose escalation to 130 mg twice daily in invasive disease
Maintenance and prophylaxis: 65 mg twice daily until immune recovery
Dose and duration should be individualized based on clinical response.
Children >4 weeks to <12 years:
1.25–2 mg/kg/dose twice daily (maximum initial dose 100 mg)
May increase to 5 mg/kg/dose twice daily in severe infections
Children ≥12 years:
50–100 mg once daily
May increase to 100 mg twice daily if required
Children ≥2 years: 2.5 mg/kg once daily (maximum 200 mg/day)
Doses should be adjusted based on therapeutic drug monitoring and rounded to the nearest 50 mg.
Common adverse effects include nausea, abdominal discomfort, dyspepsia, constipation, headache, dizziness, and elevated liver enzymes. Other reported reactions include menstrual irregularities, allergic skin reactions, hepatitis, cholestatic jaundice, peripheral neuropathy, and rare cases of Stevens–Johnson syndrome. Long-term therapy may result in hypokalemia, edema, and alopecia.
Itraconazole is contraindicated during pregnancy. Breastfeeding is not recommended during treatment due to potential risk to the infant.
Concurrent use of Nocandia with terfenadine, astemizole, cisapride, simvastatin, oral midazolam, or triazolam is contraindicated. Clinically significant interactions have also been observed with rifampin, phenytoin, phenobarbital, digoxin, and calcium channel blockers. There is no documented experience with overdose.
Itraconazole is contraindicated in patients with hypersensitivity to the drug or its components. Use is not recommended in patients with severe hepatic impairment or in those receiving rifampin due to altered metabolism.
Absorption may be reduced in patients with low gastric acidity
Antacids should be taken at least 2 hours after Nocandia
The capsule should be taken after a full meal
Liver function monitoring is recommended for treatments exceeding one month
Store below 25°C in a cool, dry place, protected from light. Keep out of reach of children.
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