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Tolsura
Tolsura (generic name: itraconazole) is an antifungal medication used to treat a variety of serious fungal infections. It belongs to the class of drugs known as azole antifungals, which work by inhibiting the growth of fungi. Tolsura is typically prescribed for systemic fungal infections such as blastomycosis, histoplasmosis, and aspergillosis. It is not intended for use in treating less severe, superficial fungal infections like athlete's foot or ringworm.
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Frequently Asked Questions
How long does it take for Tolsura to start working?
It may take several weeks to notice significant improvement, as fungal infections can take time to clear. Full treatment duration depends on the specific infection and its severity.
Can I take Tolsura with antacids?
No, it’s best to avoid taking antacids, proton pump inhibitors, or H2-blockers around the time of your Tolsura dose. These medications reduce the acidity in the stomach and can affect how well Tolsura is absorbed.
What should I do if I miss a dose of Tolsura?
If you miss a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to make up for the missed one.
Can Tolsura be used for mild fungal infections like athlete's foot?
No, Tolsura is specifically intended for serious systemic fungal infections and is not typically used for superficial infections like athlete's foot or ringworm.
Is it safe to use Tolsura long-term?
Long-term use of Tolsura should be closely monitored, especially for signs of liver toxicity or heart problems. Regular follow-up appointments and blood tests are necessary to ensure safety.
Comprehensive Drug Guide
How Does Tolsura Work?
Tolsura works by inhibiting the enzyme 14α-demethylase, which is necessary for the synthesis of ergosterol, a key component of fungal cell membranes. Without ergosterol, fungal cells cannot maintain their structure, leading to cell death and the resolution of the infection.
Common Dosages
- 65 mg oral capsules
Typical Dosing
- For systemic fungal infections: The typical dose for adults is 130 mg (two 65 mg capsules) once or twice daily, depending on the type and severity of the infection. Treatment duration varies based on the response to therapy and the specific fungal infection being treated.
Typical Dosing
FDA Approved Indications
- Blastomycosis (infection caused by the fungus Blastomyces dermatitidis)
- Histoplasmosis (infection caused by Histoplasma capsulatum)
- Aspergillosis (infection caused by the fungus Aspergillus species) in patients who cannot tolerate or have not responded to other treatments.
Who Shouldn't Take Tolsura?
- Congestive heart failure (CHF), due to the risk of worsening heart function
- Liver disease or elevated liver enzymes, unless the benefits outweigh the risks
- Known hypersensitivity to itraconazole or any components of the formulation
- Concurrent use of certain medications, such as lovastatin, simvastatin, midazolam, or triazolam (due to the risk of serious interactions)
Advice From The Pharmacist
- Take Tolsura with food, as this improves absorption and effectiveness.
- Do not use antacids or acid-reducing medications (e.g., proton pump inhibitors) within two hours before or after taking Tolsura, as this can reduce its absorption.
- Monitor for signs of liver damage, such as yellowing of the skin or eyes, dark urine, or severe fatigue, and report these symptoms to your healthcare provider immediately.
- Complete the full course of treatment as prescribed, even if you start feeling better before the infection is fully treated.
Side Effects of Tolsura
Common Side Effects
- Nausea
- Diarrhea
- Abdominal pain
- Headache
- Fatigue
Uncommon/Severe Side Effects
- Liver toxicity, including jaundice, dark urine, and elevated liver enzymes
- Congestive heart failure (worsening of symptoms in patients with heart conditions)
- Hearing loss (rare, but possible with long-term use)
- Severe allergic reactions (rash, swelling, difficulty breathing)
Risks and Warnings of Tolsura
- Liver Damage: Tolsura can cause liver damage, especially in individuals with pre-existing liver conditions. Regular monitoring of liver function tests is recommended during treatment.
- Heart Failure: Tolsura may worsen congestive heart failure (CHF) and should be avoided in patients with a history of CHF unless absolutely necessary.
- Drug Interactions: Tolsura interacts with a wide range of medications, including those used to lower cholesterol, treat anxiety, and control heart rhythm. Inform your healthcare provider of all medications you are taking before starting Tolsura.
Interactions with Tolsura
Common Drug Interactions
- Antacids: Using antacids, proton pump inhibitors, or H2-receptor antagonists can reduce the absorption of Tolsura. These medications should be taken separately.
- Statins: Combining Tolsura with certain statins (e.g., simvastatin or lovastatin) can increase the risk of serious muscle damage (rhabdomyolysis).
- Benzodiazepines: Tolsura can increase the levels of certain benzodiazepines (e.g., midazolam, triazolam), leading to excessive sedation and respiratory depression.
- Calcium channel blockers: There is an increased risk of heart failure when combining Tolsura with calcium channel blockers like verapamil.
Alternatives to Tolsura
- Voriconazole (Vfend): Another azole antifungal used for serious fungal infections, particularly aspergillosis.
- Posaconazole (Noxafil): An antifungal used for invasive fungal infections, especially in immunocompromised patients.
- Amphotericin B: A potent antifungal often used for severe, life-threatening fungal infections.
- Fluconazole (Diflucan): An alternative azole antifungal used for a variety of fungal infections, including candidiasis.
