What Is Itraconazole?

Itraconazole is a prescription antifungal medication that belongs to a class of drugs called triazole antifungals. It's used to treat a wide range of fungal infections, from nail fungus to serious systemic infections that can affect your lungs and other organs.

Itraconazole was first approved by the FDA under the brand name Sporanox. Today, it's available as a generic medication and under several brand names including Sporanox, Tolsura, and Onmel. For a deeper dive into how the medication works at a cellular level, see our article on how Itraconazole works.

What Does Itraconazole Treat?

Itraconazole is FDA-approved to treat several types of fungal infections:

Nail Fungus (Onychomycosis)

One of the most common reasons Itraconazole is prescribed is for fungal nail infections. It can treat onychomycosis of both toenails and fingernails. For nail fungus, it's often given as "pulse therapy" — 200 mg twice daily for one week, then three weeks off, repeated for 2-3 months.

Systemic Fungal Infections

Itraconazole is a go-to treatment for several serious fungal infections:

• Blastomycosis — A fungal infection found primarily in the Midwest and Great Lakes regions of the United States, affecting the lungs and sometimes other organs.
• Histoplasmosis — Common in the Ohio and Mississippi River valleys, this infection is caused by a fungus found in soil contaminated with bird or bat droppings.
• Aspergillosis — Used for patients who can't tolerate or don't respond to amphotericin B, another antifungal.

Mouth and Throat Fungal Infections

Itraconazole treats oropharyngeal candidiasis (oral thrush) and esophageal candidiasis, which are fungal infections in the mouth, throat, and esophagus. These infections are more common in people with weakened immune systems.

Off-Label Uses

Doctors also prescribe Itraconazole for conditions not listed on the official FDA label, including:

• Coccidioidomycosis (Valley fever)
• Sporotrichosis
• Skin fungal infections (tinea corporis, tinea cruris, tinea pedis)
• Tinea versicolor
• Prevention of fungal infections in immunocompromised patients
• Allergic bronchopulmonary aspergillosis (ABPA)

Itraconazole Dosage Information

Itraconazole dosing depends on what condition is being treated. Here are the general ranges — your doctor will determine the right dose for you:

• Nail fungus (toenails): 200 mg once daily for 12 consecutive weeks, OR pulse therapy of 200 mg twice daily for 1 week per month for 3-4 months
• Nail fungus (fingernails): Pulse therapy of 200 mg twice daily for 1 week per month for 2 months
• Systemic fungal infections: 200-400 mg daily, depending on the infection and severity
• Life-threatening infections: A loading dose of 200 mg three times daily for the first 3 days, followed by the standard maintenance dose
• Oral thrush: 200 mg daily (oral solution) for 1-2 weeks

How to Take Itraconazole

How you take Itraconazole matters a lot — it directly affects how well the medication works:

Capsules

• Take with a full meal to maximize absorption. Food significantly increases how much medication gets into your bloodstream.
• Swallow capsules whole — don't crush or chew them.
• Take at the same time each day for consistent blood levels.
• Avoid antacids, H2 blockers (like famotidine), and proton pump inhibitors (like omeprazole) within 2 hours, as they reduce absorption.
• If you have low stomach acid, taking capsules with an acidic beverage like cola may improve absorption.

Oral Solution

• Take on an empty stomach — the opposite of capsules!
• Swish the solution in your mouth before swallowing ("swish and swallow" technique) for oral thrush.

Important: Capsules and oral solution are not interchangeable. They have different absorption profiles, so your doctor must specify which form you should use.

Tolsura Capsules

Tolsura is a newer formulation (SUBA-Itraconazole) with improved bioavailability. A 65 mg Tolsura capsule delivers the equivalent of a 100 mg standard Itraconazole capsule. Tolsura can be taken without food.

Available Formulations

Itraconazole comes in several forms:

• Generic Itraconazole capsules — 100 mg (most widely available and affordable)
• Sporanox capsules — 100 mg (brand name)
• Sporanox oral solution — 10 mg/mL (brand name)
• Tolsura capsules — 65 mg (brand name, improved absorption)
• Onmel tablets — 200 mg (brand name, for onychomycosis only)

Generic Itraconazole capsules are the most commonly dispensed and the most affordable option. If you're having trouble finding a specific formulation, see our guide on checking pharmacy stock for Itraconazole.

Important Safety Information

Boxed Warning: Heart Failure

Itraconazole has a boxed warning (the FDA's most serious warning) about congestive heart failure. The medication can weaken the heart's pumping ability. It should not be used for nail fungus in patients with current or past heart failure. For all patients, watch for symptoms like shortness of breath, leg swelling, and rapid weight gain.

Liver Risks

Itraconazole can cause serious liver damage. Your doctor should test your liver function before starting treatment and monitor it periodically, especially during longer courses. Stop taking the medication and call your doctor if you develop jaundice (yellow skin or eyes), dark urine, or severe fatigue.

For a complete breakdown of what to watch for, read our detailed guide on Itraconazole side effects.

Drug Interactions

Itraconazole has many significant drug interactions. It strongly inhibits the CYP3A4 enzyme, which means it can raise blood levels of many other medications to dangerous levels. Several drug combinations are completely contraindicated (must never be used together), including certain cholesterol medications, sedatives, and heart rhythm drugs. See our full guide on Itraconazole drug interactions.

Pregnancy

Itraconazole should not be used for nail fungus treatment during pregnancy. For life-threatening fungal infections in pregnant patients, the decision to use Itraconazole must be made carefully with a doctor weighing risks and benefits.

Cost and Availability

Generic Itraconazole capsules typically cost $30-$150 for a 30-day supply without insurance. With discount cards, prices can drop to $15-$30. Brand-name versions are significantly more expensive — Sporanox can cost $600-$900+ for 30 capsules.

Itraconazole has experienced intermittent supply shortages, particularly the oral solution. If you're struggling to find or afford your medication, check out our guides on finding Itraconazole in stock, saving money on Itraconazole, and why Itraconazole can be hard to find.

Alternatives to Itraconazole

If Itraconazole isn't right for you or you can't find it, several alternative antifungal medications exist:

• Fluconazole — Better tolerated with fewer drug interactions, but doesn't cover Aspergillus
• Voriconazole — Broader spectrum, first-line for invasive aspergillosis
• Posaconazole — Extended spectrum, used for prophylaxis and salvage therapy
• Terbinafine — Often preferred for nail fungus due to fewer drug interactions

Your doctor can help determine which alternative is best for your specific condition. For help finding a prescriber, see our guide on finding a doctor who prescribes Itraconazole.

Healthcare providers can find additional clinical resources in our provider guides on shortage management, helping patients find stock, and cost-saving strategies.

Bottom Line

Itraconazole is a versatile antifungal medication that treats everything from nail fungus to life-threatening systemic infections. Taking it correctly — capsules with food, oral solution on an empty stomach — is key to getting the best results. Work closely with your doctor to monitor for side effects and drug interactions, and don't hesitate to ask questions about your treatment.