Veterinary Itraconazole Bioassay for Antifungal Therapeutic Drug Monitoring

Clinical Recommendations for Animals Receiving Itraconazole Treatment for Serious Fungal Infections

Avoid Itraconazole Compounded from Bulk Powder

A recent clinical study performed at MiraVista Diagnostics (published in JAAHA) 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
  • Low Blood Levels in Patients
Leverage Itraconazole Bioassays to Achieve Therapeutic Levels and Mitigate Common Risks Associated with Antifungal Drug Treatment
Subtherapeutic Concentrations
  • 95% subtherapeutic with compounded intraconazole
  • 12.5% subtherapeutic with generic itraconazole
  • 12.1% subtherapeutic with brand name itraconazole
Potentially Toxic Blood Levels
  • 35% toxic levels with generic itraconazole
  • 24% toxic levels with brand name itraconazole
Inappropriate Dosing & Duration
  • Subtherapeutic levels can extend treatment time & necessitate repeat treatment
  • Dosage, duration & frequency impact treatment costs
Antifungal Therapeutic Drug Monitoring Improves Veterinary Itraconazole Treatment Outcomes
  • Confirm therapeutic levels
  • Lower treatment cost
  • Limit treatment time
  • Improve dose accuracy