Adults

Varies by indication: e.g., Onychomycosis: 200 mg once daily for 3 months or pulse therapy (200 mg twice daily for 1 week, followed by 3 weeks off, for 2-3 cycles). Systemic candidiasis: 100-200 mg once or twice daily.

Elderly

No specific dose adjustment is generally required, but caution should be exercised due to potential age-related organ function decline.

Renal_impairment

Use with caution; dose adjustment may be necessary. Plasma concentrations may be higher in patients with renal impairment.

Onset

Therapeutic effects may take several days to weeks to appear, depending on the infection type and location.

Excretion

Excreted mainly as inactive metabolites: approximately 35% in urine and 54% in feces. Less than 0.05% is excreted unchanged in urine.

Half life

The elimination half-life is approximately 15-42 hours, with steady-state concentrations achieved within 7-14 days.

Absorption

Oral absorption is variable and significantly increased when taken with food. Bioavailability is approximately 55% and can be further enhanced by acidic conditions.

Metabolism

Extensively metabolized in the liver, primarily by the cytochrome P450 3A4 (CYP3A4) enzyme system, into various metabolites, including the active metabolite hydroxy-icand.

Warfarin

Enhanced anticoagulant effect. Monitor INR closely and adjust warfarin dose.

Oral Midazolam/Triazolam

Increased sedation and prolonged effects. Avoid co-administration.

Proton Pump Inhibitors/Antacids

Reduce gastric acidity, impairing icand absorption. Administer at least 2 hours apart.

Statins (e.g., Simvastatin, Lovastatin)

Increased risk of myopathy/rhabdomyolysis due to elevated statin levels. Co-administration is contraindicated.

CYP3A4 Inducers (e.g., Rifampicin, Phenytoin)

May significantly decrease icand plasma levels, reducing efficacy. Avoid co-administration.

CYP3A4 Inhibitors (e.g., Ritonavir, Clarithromycin)

May significantly increase icand plasma levels, increasing risk of adverse effects. Dose adjustment may be necessary.