Sporanox and Zocor

What is Sporanox?

Sporanox is a Brand name for antifungal drug containing itraconazole as an active ingredient. Itraconazole is in a group of antifungals drugs called triazoles.

This drug fights infections that are caused by fungus, which can invade any part of the body including the mouth or throat, lungs, toenails, or fingernails.

It has a broader activity spectrum than fluconazole, but also less broad than voriconazole or posaconazole. Sporanox is active against Aspergillus, Blastomycosis, histoplasmosis, sporotrichosis, and onychomycosis.

Itraconazole has over 99% protein-bound and has virtually no penetration into cerebrospinal fluid thus it is not used to treat meningitis or other CNS infections.

However treatment with Sporanox has been successful for cryptococcal and coccidioidal meningitis. It is available in a form of a capsule and a solution (liquid) to be taken by mouth.

Other Brand names on a market containing itraconazole as an active ingredient are: Itrizol, Onmel, Oriconazol and Sporal.

What is the drug Sporanox used for?

Zocor medication

Zocor is a Brand name for a drug that contain simvastatin as an active ingredient which belongs to a group of drugs called HMG CoA reductase inhibitors, also known as “statins.”

Simvastatin works by reducing the levels of “bad” cholesterol – LDL (low-density lipoprotein), and triglycerides in the blood, while increasing levels of “good” cholesterol – HDL (high-density lipoprotein).

It is also used to reduce the risk of heart attack, stroke and other heart complications in people with diabetes, coronary heart disease, or other risk factors. Zocor is used in adults and children who are at least 10 years old.

Other Brand names for drugs containing simvastatin as an active ingredient are: Cholestat, Lipex, Sinvacor, Sivastin, Sorfox and Statex.

Zocor tablets
Zocor tablets

How does Sporanox and Zocor work in the body?

Itraconazole belong to imidazole/triazole group of antifungal agents. It works by inhibiting the enzyme cytochrome P450 14α-demethylase. This enzyme is important because it converts lanosterol to ergosterol, and is required in fungal cell wall synthesis.

The loss of normal sterols links with the accumulation of 14 α-methyl sterols in fungi and may be partly responsible for the fungistatic activity of this drug. Mammalian cell demethylation is much less sensitive to fluconazole inhibition.

Itraconazole exhibits in vitro activity against Candida spp and Cryptococcus neoformans. Fungistatic activity has also been confirmed in normal and immunocompromised animal models for systemic and intracranial fungal infections caused by Cryptococcus neoformans and for systemic infections caused by Candida albicans.

Simvastatin is a lipid-lowering drug that is synthetically derived from the fermentation of fungi Aspergillus terreus. It is a potent competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, rate-limiting enzyme in biosynthesis of cholesterol.

Interference with this enzyme activity reduces the quantity of mevalonic acid, a precursor of cholesterol. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL cholesterol.

Can patients take Sporanox and Zocor together?

Patients must avoid this combination because of high risk for dangerous interaction. Itraconazole oral can increase the blood level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism and increasing the risk for rhabdomyolysis with drugs that increase simvastatin systemic exposure.

Rhabdomyolysis is a serious condition in which damaged skeletal striated muscle cells breaks down very fast. Breakdown products of damaged muscle cells are released into the bloodstream.

Some of these products, such as the protein myoglobin, can be very harmful to the kidneys and may lead to kidney failure, disseminated intravascular coagulation and death.

Also, simvastatin may increase the level or effect of itraconazole oral by affects how the drug is eliminated from the body through P-glycoprotein [MDR1] transporter.

The table below shows the incidence of side effects after Sporanox and Zocor administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.

Common side effects 1-10% Nausea (11%), Rash (9%), Abdominal pain (7%), Upper respiratory infection (9%), Headache (3-7%), Myalgia (5%), CPK elevation (>3x ULN) (5%) Eczema (5%), Vomiting (5%) Vertigo (5%), Edema (4%), Abnormal liver function test results (3%), Diarrhea (3%), Pruritus (3%), Fever (3%), Hypertension (3%), Fatigue (2-3%), Hypertriglyceridemia (2%), Hypokalemia (2%), Dizziness (2%), Constipation (2%), Flatulence (1-2%), Anorexia (1%), Decreased libido (1%), Hepatitis (1%), Albuminuria (1%), Malaise (1%), Transaminases increased (1%)

Special precautions and warnings during Sporanox and Zocor administration:

  • Patients should tell their doctor and pharmacist if they are allergic to Sporanox or Zocor, or any other medications, or any of the ingredients in these products.
  • Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take.
  • In rare cases, simvastatin can cause a serious condition that result in skeletal muscle tissue breakdown, leading to kidney failure. Patients should call doctor immediately if they experience unexplained muscle pain, tenderness, or weakness especially if they also have unusual tiredness, fever and dark colored urine.
  • Before taking Zocor, patients should tell their doctor if they have ever had kidney or liver disease thyroid disorder or diabetes if they are Chinese descent, or if they drink more than 2 alcoholic beverages daily.
  • Grapefruit and grapefruit juice may interact with simvastatin leading to potentially dangerous effects. Patients should not consume grapefruit products while taking Zocor.
  • In rare cases Sporanox can cause heart failure. Patients should tell their doctor if they have or have ever had heart failure. Doctor may tell patients not to take Sporanox. Patients should also tell their doctor if they have or have ever had irregular heartbeat; heart attack; or any other type of lung, liver heart, or kidney disease. If patients experience any of the following symptoms such as: shortness of breath; weakness; excessive tiredness; coughing up white or pink phlegm; fast heartbeat; swelling of the ankles, or legs; feet, waking up at night; and sudden weight gain, they should stop taking Sporanox and call their doctor immediately.
  • Patients on Sporanox therapy should tell their doctor and pharmacist if they are taking following medicines or if they took them in the last 2 weeks before starting therapy with itraconazole: carbamazepine, efavirenz, isoniazid, rifabutin, rifampicin; nevirapine, phenobarbital; and phenytoin.
  • If patients are taking an antacid while they are on Sporanox therapy, take should take it 1 hour before or 2 hours after they take Sporanox.
  • Patients using Sporanox have to tell their doctor if they have or have ever had the conditions such as cystic fibrosis or any other condition that reduces the amount of acid in stomach, or HIV infection.
  • Women using Sporanox should tell their doctor if they are pregnant, plan to become pregnant, or are breastfeeding. Patients should not take this drug to treat nail fungus if you are pregnant or could become pregnant.
  • Sporanox can make patients dizzy or cause blurred or double vision. They should not drive a car or operate machinery until they know how this medication affects them.

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