Itraconazole capsules need an acidic stomach and food to dissolve and be absorbed. Patients on proton pump inhibitors or H2 blockers can have very low levels and apparent treatment failure. The oral solution is absorbed better on an empty stomach and is less affected by acid suppression, and super-bioavailable formulations reduce the problem further. When an azole seems not to be working, check the acid suppressant and the level before switching drugs.
- Give itraconazole capsules with a full meal.
- Stop or avoid PPIs and H2 blockers during capsule therapy if possible.
- Consider the oral solution, taken fasting, when acid suppression cannot be stopped.
- Check a trough level after about two weeks in serious infection.
Why it matters
Poor absorption, not resistance, is one of the commonest reasons an azole appears to fail.
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