Синтетическое противогрибковое средство широкого спектра действия, производное триазола. Ингибирует синтез эргостерола, являющегося важным компонентом клеточной мембраны грибов. Итраконазол активен в отношении дерматофитов (Trichophyton spp., Microsporum spp., Epidermophyton floccosum); дрожжеподобных грибов и дрожжей (Cryptococcus neoformans, Pityrosporum spp., Trichosporon spp., Geotrichum spp., Candida spp., включая Candida albicans, Candida glabrata и Candida krusei); Aspergillus spp., Histoplasma spp., Paracoccidioides brasiliensis, Sporothrix schenckii, Fonsecaea spp., Cladosporium spp., Blastomyces dermatitidis, Pseudallescheria boydii, Penicillium marneffei, а также других дрожжевых и плесневых грибов.
Показания к применению
Дерматомикозы
Грибковый кератит
Онихомикозы, вызванные дерматофитами и/или дрожжами и плесневыми грибами
Системные микозы:
Системный аспергиллез и кандидоз
Криптококкоз, включая криптококковый менингит (пациентам с иммунодефицитом и пациентам с криптококкозом центральной нервной системы Кандитрал должен назначаться только в случаях, если препараты первой линии лечения не применимы в данном случае или не эффективны)
Гистоплазмоз
Споротризоз
Паракокцидиоидомикоз
Бластомикоз
Другие системные или тропические микозы
Кандидомикозы с поражением кожи и слизистых, в том числе вульвовагинальный кандидоз
Глубокие висцеральные кандидозы
Отрубевидный лишай
Противопоказания
Индивидуальная повышенная чувствительность к препарату или его компонентам
Одновременный с препаратом Кандитрал прием следующих лекарственных средств:
Препараты, метаболизируемые ферментом CYP3A4, которые могут увеличивать QT интервал (терфенадин, астемизол, мизоластин, цизаприд, дофетилид, хинидин, пимозид, левометадон, сертиндол)
Препараты алкалоидов спорыньи (дигидроэрготамин, эргометрин, эрготамин и метилэргометрин)
Детский возраст до 3-х лет. С осторожностью: детский возраст, тяжелая сердечная недостаточность, заболевания печени (в том числе сопровождающиеся печеночной недостаточностью), хроническая почечная недостаточность
Применение при беременности и в период грудного вскармливания
Применение препарата при беременности возможно только в том случае, когда предполагаемая польза для матери превосходит потенциальный риск для плода. При необходимости применения препарата в период лактации следует решить вопрос о прекращении грудного вскармливания.
Побочное действие
Со стороны желудочно-кишечного тракта: диспепсия, тошнота, рвота, снижение аппетита, боль в животе, диарея, запор. Со стороны гепато-билиарной системы: обратимое повышение активности "печеночных"трансаминаз, гепатит; очень редко – тяжелое токсическое поражение печени, в том числе острая печеночная недостаточность с летальным исходом. Со стороны нервной системы: головная боль, головокружение, периферическая нейропатия. Аллергические реакции: кожная сыпь, кожный зуд, крапивница, ангионевротический отек, редко - мультиформная экссудативная эритема (синдром Стивенса-Джонсона). Со стороны кожных покровов: алопеция, светочувствительность Прочие: нарушения менструального цикла, гипокалиемия, отечный синдром, застойная сердечная недостаточность и отек легких, гиперкреатинемия, окрашивание мочи в темный цвет.
Передозировка
Данные отсутствуют. При случайной передозировке следует провести промывание желудка в течение первого часа, назначить активированный уголь. Гемодиализ не эффективен. Специфического антидота не существует.
Особые указания
Женщинам детородного возраста, принимающим Кандитрал, необходимо использовать адекватные меры контрацепции на протяжении всего курса лечения вплоть до наступления первой менструации после его завершения. При исследовании в/в лекарственной формы препарата Итраконазол отмечалось преходящее бессимптомное уменьшение фракции выброса левого желудочка, нормализовавшееся до следующей инфузии препарата. Обнаружено, что итраконазол обладает отрицательным инотропным эффектом. Сообщалось о случаях развития сердечной недостаточности, связанных с приемом Кандитрала. Кандитрал не следует принимать пациентам с хронической сердечной недостаточностью или с наличием этого заболевания в анамнезе за исключением случаев, когда возможная польза значительно превосходит потенциальный риск. Блокаторы кальциевых каналов могут оказывать отрицательный инотропный эффект, который может усиливать подобный эффект итраконазола; итраконазол может снижать метаболизм блокаторов кальциевых каналов. При одновременном приеме итраконазола и блокаторов кальциевых каналов необходимо соблюдать осторожность. У пациентов с почечной недостаточностью биодоступность итраконазола может быть снижена, что может потребовать коррекции дозы. При пониженной кислотности желудка абсорбция итраконазола нарушается. Пациентам, принимающим антацидные препараты (например, гидроксид алюминия), рекомендуется их использовать не ранее, чем через 2 ч после приема Кандитрала. Пациентам с ахлоргидрией или применяющим Н2-гистамин блокаторы или ингибиторы протоновой помпы, рекомендуется принимать капсулы Кандитрала с кислыми напитками. В очень редких случаях при применении Кандитрала развивалось тяжелое токсическое поражение печени, в том числе случаи острой печеночной недостаточности с летальным исходом. Это происходило с пациентами, у которых уже имелись заболевания печени, а также у пациентов, получавших другие лекарственные средства, обладающие гепатотоксическим действием. Несколько таких случаев возникли в первый месяц терапии, а некоторые – в первую неделю лечения. В связи с этим рекомендуется регулярно контролировать функцию печени у больных, получающих терапию итраконазолом. Лечение следует прекратить при возникновении нейропатии, которая может быть связана с приемом капсул Кандитрала. Нет данных о перекрестной гиперчувствительности к итраконазолу и другим азоловым противогрибковым препаратам. Кандитрал в капсулах следует с осторожностью назначать пациентам с гиперчувствительностью к другим азолам. Пациентам с нарушенным иммунитетом (СПИД, после трансплантации органов, нейтропенией) может потребоваться увеличение дозы Кандитрала. Применение в педиатрии Кандитрал не следует назначать детям, за исключением случаев, когда ожидаемая польза превышает возможный риск. Воздействие на способность водить автомобиль и работать с техникой Не наблюдалось.
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