ITRACONAZOLE: AFFORDABLE FLUCONAZOLE SUBSTITUTE

Fluconazole is a very good antifungal which is taken by mouth; it is effective for cryptococcal meningitis and many other fungal infections. It is approved in England, but not in the United States, apparently because of bureaucratic snafus. Some people have obtained personal supplies from England, but the drug is very expensive; maintenance doses for cryptococcal meningitis can cost almost as much as AZT, and insurance will not pay for fluconazole because it is not approved.

Another drug, itraconazole (brand name Sporanox) may be almost as good as fluconazole but much less expensive. Itraconazole is used to treat many different fungal diseases. It may be less effective than fluconazole for cryptococcal meningitis, how ever, although it is sometimes used for that condition (see references, below). Itraconazole is available in Mexico, and it either is or is soon expected to be available in the UK. We do not have exact price information, but have heard that treatment with itraconazole (obtained from Mexico) costs about $1.50 to $3.00 per day, depending on the dose.

Anyone considering using fluconazole or itraconazole should also consider the more conventional options. Amphotericin B (AMB), which is readily available, is probably at least as effective as fluconazole. Its drawbacks are that it must be given intravenously, it can cause unpleasant side effects, and some patients cannot tolerate it at all.

If AMB cannot be used, a patient may be able to qualify for a trial of fluconazole, or for compassionate use, in which case the drug will probably be free. Physicians only who want to find out how to enroll their patients should call the developer, Pfiser Inc., at 203/441-4112.

If these options do not work, then for more information about obtaining fluconazole or itraconazole from abroad, patients can call the PWA Health Group, 212/532-0280.

References

De Gans, J and others. Itraconazole as maintenance treatment for cryptococcal meningitis in the acquired immune deficiency syndrome. British Medical Journal 296/6618 (339), 1988.

Dismukes, WE. Azole antifungal drugs: old and new. Annals of Internal Medicine volume 109 number 3, pages 177-179, August 1, 1988.

Dupont, B. Attack and maintenance cure of cryptococcal meningitis in AIDS patients. (English translation of French title.) Med. Mal. Infect., volume 18, special issue 215, pages 737-741.

Saag, MS and Dismukes, WE. Azole antifungal agents: emphasis on new triazoles. Antimicrobial Agents and Chemotherapy volume 32 number 1, pages 1-8, January 1988.

Tucker, RM and others. Treatment of mycoses with itraconazole. Annals of the New York Academy of Sciences number 544, pages 451-470, 1988.

Wishart, JM. The influence of food on the pharmacokinetics of itraconazole in patients with superficial fungal infection. Journal of the American Academy of Dermatology volume 17 number 2 part 1, pages 220-223, August 1987.