Therapeutic Drug Monitoring

Clinical Recommendations for Veterinary Itraconazole Treatment for Serious Fungal Infections in Animals

The research team at MiraVista Diagnostics offers helpful clinical recommendations and revealing insights to veterinarians that are using itraconazole to treat serious fungal infections in animals.

drugmonitoring-campaign-726x200

RECOMMENDATION #1: Avoid Itraconazole Compounded from Bulk Powder

A recent clinical study performed at MiraVista Diagnostics revealed that 95% of dogs and cats receiving itraconazole compounded from bulk powder had a subtherapeutic blood concentration of itraconazole.

Generic pelletized itraconazole (both FDA approved and non-FDA approved) produced similar blood concentration levels in dogs and cats as compared to brand name itraconazole (Sporanox by Janssen Pharmaceuticals) capsules or oral solution. Some animals in the generic and the brand name groups demonstrated subtherapeutic levels or potentially toxic levels.

ISSUES WITH COMPOUNDED ITRACONAZOLE

  • Low Solubility
  • Questionable Stability
  • Inconsistent Blood Levels in Patients

RECOMMENDATION #2: Perform Antifungal Therapeutic Drug Monitoring (TDM) During Itraconazole Treatment

Antifungal therapeutic drug monitoring (TDM) measures itraconazole blood concentration levels and provides quantifiable feedback for treatment response, dosage, duration and frequency.

VET-TDM-GRAPH-083116

RECOMMENDATION #3: Know (and Mitigate) Common Risks Associated with Antifungal Drug Treatment

Leverage a reliable veterinary itraconazole bioassay to achieve therapeutic levels and mitigate risks associated with antifungal drug treatment. Here are the most common adverse responses to itraconazole treatment:

SUBTHERAPEUTIC  ITRACONAZOLE CONCENTRATIONS

  • 95% of subjects had subtherapeutic concentrations with compounded itraconazole
  • 12.5% of subjects had subtherapeutic concentrations with generic itraconazole
  • 12.1% of subjects had subtherapeutic concentrations with brand name itraconazole

POTENTIALLY TOXIC BLOOD LEVELS OF ITRACONAZOLE

  • 38% of subjects had potentially toxic levels with generic itraconazole
  • 24% of subjects had potentially toxic levels with brand name itraconazole

INAPPROPRIATE ITRACONAZOLE DOSING & DURATION

  • Subtherapeutic itraconazole concentrations can extend treatment time & necessitate repeat treatment
  • Dosage, duration & frequency impact treatment cost

Antifungal Therapeutic Drug Monitoring Improves Veterinary Itraconazole Treatment Outcomes

TDM-advantages083115

REFERENCES:
(1) Renschler JS, Albers AJ, Sinclair-Mackling HR and Wheat LJ. Comparison of compounded, generic and innovator-formulated itraconazole in dogs and cats. J Am Anim Hosp Assoc (in press).
(2) J.A. Smith, M.G. Papich, G. Russell and M.A. Mitchell. Effects of compounding on pharmacokinetics of itraconazole in black-footed penguins (Spheniscus demersus). J Zoo Wildlife Med 2010; 41(3): 487-495.

Download MiraVista’s full clinical recommendations →

LEARN MORE
  • vendor logo
  • vendor logo
  • vendor logo
  • vendor logo
  • vendor logo