VETgirl Q1 2021 Beat e-Newsletter

ANTIFUNGAL THERAPY: PAST, PRESENT, AND FUTURE

ANDREW HANZLICEK, DVM, MS, DACVIM MiraVista Diagnostics, Indianapolis, Indiana

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TABLE 2. Recommended dosage of select antifungal drugs in dogs and cats

Route PO

Drug Itraconazole*

Species Dog

Formulation Capsule or

Dose 10 mg/kg/day for 3 days then 5 mg/kg/day

Solution Capsule Solution

Cat

10 mg/kg/day 5 mg/kg/day 20 mg/kg/day 20 mg/kg/day 5 mg/kg EOD 5 mg/kg BID 15 mg/kg once then 7.5 mg/kg/day 5 mg/kg BID 12.5 mg (total dose) q 72 h 1-2 mg/kg EOD Cumulative dose 24 mg/kg 0.5-1 mg/kg EOD Cumulative dose 12 mg/kg

PO

Fluconazole

Dog Cat Dog

Tablet or Solution Tablet or Solution Tablet ER Solution Solution Tablet or Solution

PO

Posaconazole

Cat Dog Cat Dog

PO

Voriconazole

Solution Solution

IV

Amphotericin B (lipid or liposomal)

Cat

Solution

*Starting dose only. Individualized dose should be determined based on itraconazole blood levels.

References 1. Legendre AM, Rohrbach BW, Toal RL, et al. Treatment of blastomycosis with itraconazole in 112 dogs. J Vet Intern Med 1996; 10: 365-371. DOI: 10.1111/j.1939-1676.1996.tb02082.x. 2. KuKanich K, KuKanich B, Lin Z, et al. Clinical pharmacokinetics and outcomes of oral fluconazole therapy in dogs and cats with naturally occurring fungal disease. J Vet Pharmacol Ther 2020. DOI: 10.1111/jvp.12888. 3. Renschler J, Albers A, Sinclair-Mackling H, et al. Comparison of Compounded, Generic, and Innovator- Formulated Itraconazole in Dogs and Cats. J Am Anim Hosp Assoc 2018; 54: 195-200. DOI: 10.5326/JAAHA- MS-6591. 4. Middleton SM, Kubier A, Dirikolu L, et al. Alternate-day dosing of itraconazole in healthy adult cats. J Vet Pharmacol Ther 2016; 39: 27-31. DOI: 10.1111/jvp.12231. 5. Mawby DI, Whittemore JC, Fowler LE, et al. Comparison of absorption characteristics of oral reference and compounded itraconazole formulations in healthy cats. J Am Vet Med Assoc 2018; 252: 195-200. DOI: 10.2460/javma.252.2.195. 6. Mawby DI, Whittemore JC, Genger S, et al. Bioequivalence of orally administered generic, compounded, and innovator-formulated itraconazole in healthy dogs. J Vet Intern Med 2014; 28: 72-77. DOI: 10.1111/ jvim.12219.

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