Trioxal Uses

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What is Trioxal?

Trioxal is used to treat serious fungal or yeast infections. Trioxal oral solution is only used to treat oropharyngeal or esophageal candidiasis (thrush, oral thrush). Trioxal capsule is used to treat fungal infections, such as aspergillosis (fungal infection in the lungs), blastomycosis (Gilchrist’s disease), histoplasmosis (Darling’s disease), or onychomycosis (fungal infection in the fingernails or toenails). Trioxal tablet is only used to treat onychomycosis of the toenails. Trioxal works by killing the fungus or yeast and preventing its growth.

Trioxal is available only with your doctor's prescription.

Trioxal indications

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Trioxal® (Trioxal) Injection/Oral Solution is indicated for empiric therapy of febrile neutropenic patients with suspected fungal infections. (NOTE: In a comparative trial, the overall response rate for Trioxal-treated subjects was higher than for amphotericin B-treated subjects. However, compared to amphotericin B-treated subjects, a larger number of Trioxal-treated subjects discontinued treatment due to persistent fever and a change in antifungal medication due to fever. Whereas, a larger number of amphotericin B-treated subjects discontinued due to drug intolerance.

Trioxal® (Trioxal) Injection is also indicated for the treatment of the following fungal infections in immunocompromised and non-immunocompromised patients:

  1. Blastomycosis, pulmonary and extrapulmonary;
  2. Histoplasmosis, including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis; and
  3. Aspergillosis, pulmonary and extrapulmonary, in patients who are intolerant of or who are refractory to amphotericin B therapy.

Specimens for fungal cultures and other relevant laboratory studies (wet mount, histopathology, serology) should be obtained prior to therapy to isolate and identify causative organisms. Therapy may be instituted before the results of the cultures and other laboratory studies are known; however, once these results become available, anti-infective therapy should be adjusted accordingly.

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How should I use Trioxal?

Use Trioxal tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Trioxal tablets.

Uses of Trioxal in details

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Use: Labeled Indications

Aspergillosis (capsules): Treatment of pulmonary and extrapulmonary aspergillosis in immunocompromised and nonimmunocompromised patients who are intolerant of or refractory to amphotericin B therapy. Note: IDSA Aspergillosis guidelines recommend amphotericin B formulations for invasive aspergillosis (initial or salvage) only when voriconazole is contraindicated or not tolerated (IDSA [Patterson 2016]).

Blastomycosis (capsules): Treatment of pulmonary and extrapulmonary blastomycosis in immunocompromised and nonimmunocompromised patients.

Histoplasmosis (capsules): Treatment of histoplasmosis, including chronic cavitary pulmonary disease and disseminated, nonmeningeal histoplasmosis in immunocompromised and nonimmunocompromised patients.

Onychomycosis:

Capsules (100 mg [Trioxal]): Treatment of onychomycosis of the toenail, with or without fingernail involvement, and onychomycosis of the fingernail caused by dermatophytes (tinea unguium) in nonimmunocompromised patients

Tablets: Treatment of onychomycosis of the toenail caused by Trichophyton rubrum or Trichophyton mentagrophytes in nonimmunocompromised patients

Oropharyngeal/Esophageal candidiasis (oral solution): Treatment of oropharyngeal and esophageal candidiasis

Canadian labeling:

Oral capsules: Additional indications (not in US labeling):

Candidiasis, oral and/or esophageal: Treatment of oral and/or esophageal candidiasis in immunocompromised and immunocompetent patients

Chromomycosis: Treatment of chromomycosis in immunocompromised and immunocompetent patients

Dermatomycoses: Treatment of dermatomycoses due to tinea pedis, tinea cruris, tinea corporis, and of pityriasis versicolor in patients for whom oral therapy is appropriate

Onychomycosis: Treatment of onychomycosis in immunocompromised and immunocompetent patients

Paracoccidioidomycosis: Treatment of paracoccidioidomycosis in immunocompromised and immunocompetent patients

Sporotrichosis: Treatment of cutaneous and lymphatic sporotrichosis in immunocompromised and immunocompetent patients

Off Label Uses

Candidiasis, vulvovaginal in HIV-infected patients

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Trioxal oral solution is an effective and recommended alternative agent in the management of vulvovaginal candidiasis in HIV-infected patients.

Coccidioidal meningitis in HIV-infected patients

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Trioxal is an effective and recommended alternative agent in the treatment of and as chronic suppressive therapy of coccidioidal meningitis in HIV-infected patients.

Coccidioidal pneumonia in HIV-infected patients

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Trioxal is an effective and recommended agent in the treatment of coccidioidal pneumonia (focal pneumonia) in HIV-infected patients.

Coccidioidomycosis (non-HIV infected)

Based on the Infectious Diseases Society of America (IDSA) guidelines for the treatment of coccidioidomycosis, Trioxal is an effective and recommended agent for the treatment of coccidioidomycosis, including coccidioidal meningitis and certain types of pulmonary and extrapulmonary infections.

Cryptococcosis in HIV-infected patients

Based on the HHS Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Trioxal is an effective and recommended alternative agent in the treatment (consolidation therapy) of cryptococcal meningitis in HIV-infected patients.

Microsporidiosis, disseminated in HIV-infected patients

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Trioxal is an effective and recommended agent in the management of disseminated microsporidiosis caused by Trachipleistophora or Anncaliia in HIV-infected patients.

Penicilliosis in HIV-infected patients

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Trioxal is an effective and recommended agent in the treatment or primary prophylaxis of penicilliosis in HIV-infected patients.

Trioxal description

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Each capsule contains Itraconazole 100 mg in a pellet formulation for oral administration. The inactive ingredients are sucrose, corn starch, hydrolysed starch syrup, hypromellose and macrogol. The capsule itself contains titanium dioxide, indigotindisulfonate sodium, coccine nouvelle and gelatin.

Trioxal oral solution also contains hydroxypropyl β-cyclodextrin, sorbitol, propylene glycol, hydrochloric acid, cherry flavour 1, cherry flavour 2, caramel flavour, sodium saccharin, sodium hydroxide and purified water.

Trioxal dosage

Trioxal Dosage

Generic name: Trioxal 200mg

Dosage form: tablet

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Trioxal should be taken with a full meal at the same time each day. The recommended dose is 200 mg (one tablet) once daily for 12 consecutive weeks.

Use in Patients with Renal Impairment:

Limited data are available on the use of oral Trioxal in patients with renal impairment. Caution should be exercised when Trioxal is administered to patients with renal impairment.

Use in Patients with Hepatic Impairment:

Limited data are available on the use of oral Trioxal in patients with hepatic impairment. Caution should be exercised when Trioxal is administered to patients with hepatic impairment.

More about Trioxal (Trioxal)

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Trioxal interactions

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What other drugs will affect Trioxal?

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Trioxal and its major metabolite, hydroxyitraconazole, are inhibitors of CYP3A4. Therefore, the following drug interactions may occur :

  1. Trioxal® (Trioxal injection) may decrease the elimination of drugs metabolized by CYP3A4, resulting in increased plasma concentrations of these drugs when they are administered with Trioxal® (Trioxal injection). These elevated plasma concentrations may increase or prolong both therapeutic and adverse effects of these drugs. Whenever possible, plasma concentrations of these drugs should be monitored, and dosage adjustments made after concomitant Trioxal® (Trioxal injection) therapy is initiated. When appropriate, clinical monitoring for signs or symptoms of increased or prolonged pharmacologic effects is advised. Upon discontinuation, depending on the dose and duration of treatment, Trioxal plasma concentrations decline gradually (especially in patients with hepatic cirrhosis or in those receiving CYP3A4 inhibitors). This is particularly important when initiating therapy with drugs whose metabolism is affected by Trioxal.
  2. Inducers of CYP3A4 may decrease the plasma concentrations of Trioxal. Trioxal® (Trioxal injection) may not be effective in patients concomitantly taking Trioxal® (Trioxal injection) and one of these drugs. Therefore, administration of these drugs with Trioxal® (Trioxal injection) is not recommended.
  3. Other inhibitors of CYP3A4 may increase the plasma concentrations of Trioxal. Patients who must take Trioxal® (Trioxal injection) concomitantly with one of these drugs should be monitored closely for signs or symptoms of increased or prolonged pharmacologic effects of Trioxal® (Trioxal injection).

Table 1: Selected Drugs that are Predicted to Alter the Plasma Concentration of Trioxal or Have Their Plasma Concentration Altered by Trioxal® (Trioxal injection) For information on parenterally administered midazolam, see the Benzodiazepine paragraph below.

Antiarrhythmics

The class IA antiarrhythmic quinidine and class III antiarrhythmic dofetilide are known to prolong the QT interval. Coadministration of quinidine or dofetilide with Trioxal® (Trioxal injection) may increase plasma concentrations of quinidine or dofetilide which could result in serious cardiovascular events. Therefore, concomitant administration of Trioxal® (Trioxal injection) and quinidine or dofetilide is contraindicated.

The class IA antiarrhythmic disopyramide has the potential to increase the QT interval at high plasma concentrations. Caution is advised when Trioxal® (Trioxal injection) and disopyramide are administered concomitantly.

Concomitant administration of digoxin and Trioxal® (Trioxal injection) has led to increased plasma concentrations of digoxin via inhibition of P-glycoprotein.

Anticonvulsants

Reduced plasma concentrations of Trioxal were reported when Trioxal® (Trioxal injection) was administered concomitantly with phenytoin. Carbamazepine, phenobarbital, and phenytoin are all inducers of CYP3A4. Although interactions with carbamazepine and phenobarbital have not been studied, concomitant administration of Trioxal® (Trioxal injection) and these drugs would be expected to result in decreased plasma concentrations of Trioxal. In addition, in vivo studies have demonstrated an increase in plasma carbamazepine concentrations in subjects concomitantly receiving ketoconazole. Although there are no data regarding the effect of Trioxal on carbamazepine metabolism, because of the similarities between ketoconazole and Trioxal, concomitant administration of Trioxal® (Trioxal injection) and carbamazepine may inhibit the metabolism of carbamazepine.

Antimycobacterials

Drug interaction studies have demonstrated that plasma concentrations of azole antifungal agents and their metabolites, including Trioxal and hydroxyitraconazole, were significantly decreased when these agents were given concomitantly with rifabutin or rifampin. In vivo data suggest that rifabutin is metabolized in part by CYP3A4. Trioxal® (Trioxal injection) may inhibit the metabolism of rifabutin. Although no formal study data are available for isoniazid, similar effects should be anticipated. Therefore, the efficacy of Trioxal® (Trioxal injection) could be substantially reduced if given concomitantly with one of these agents. Coadministration is not recommended.

Antineoplastics

Trioxal® (Trioxal injection) may inhibit the metabolism of busulfan, docetaxel, and vinca alkaloids.

Antipsychotics

Pimozide is known to prolong the QT interval and is partially metabolized by CYP3A4. Coadministration of pimozide with Trioxal® (Trioxal injection) could result in serious cardiovascular events. Therefore, concomitant administration of Trioxal® (Trioxal injection) and pimozide is contraindicated.

Benzodiazepines

Concomitant administration of Trioxal® (Trioxal injection) and alprazolam, diazepam, oral midazolam, or triazolam could lead to increased plasma concentrations of these benzodiazepines. Increased plasma concentrations could potentiate and prolong hypnotic and sedative effects. Concomitant administration of Trioxal® (Trioxal injection) and oral midazolam or triazolam is contraindicated. If midazolam is administered parenterally, special precaution and patient monitoring is required since the sedative effect may be prolonged.

Calcium Channel Blockers

Edema has been reported in patients concomitantly receiving Trioxal® (Trioxal injection) and dihydropyridine calcium channel blockers. Appropriate dosage adjustment may be necessary.

Calcium channel blockers can have a negative inotropic effect which may be additive to those of Trioxal; Trioxal can inhibit the metabolism of calcium channel blockers such as dihydropyridines (e.g., nifedipine and felodipine) and verapamil. Therefore, caution should be used when co-administering Trioxal and calcium channel blockers due to an increased risk of CHF. Concomitant administration of Trioxal® (Trioxal injection) and nisoldipine results in clinically significant increases in nisoldipine plasma concentrations which cannot be managed by dosage reduction, therefore the concomitant administration of Trioxal® (Trioxal injection) and nisoldipine is contraindicated.

Gastrointestinal Motility Agents

Coadministration of Trioxal® (Trioxal injection) with cisapride can elevate plasma cisapride concentrations which could result in serious cardiovascular events. Therefore, concomitant administration of Trioxal® (Trioxal injection) with cisapride is contraindicated.

HMG CoA-Reductase Inhibitors

Human pharmacokinetic data suggest that Trioxal® (Trioxal injection) inhibits the metabolism of atorvastatin, cerivastatin, lovastatin, and simvastatin, which may increase the risk of skeletal muscle toxicity, including rhabdomyolysis. Concomitant administration of Trioxal® (Trioxal injection) with HMG CoA-reductase inhibitors, such as lovastatin and simvastatin, is contraindicated.

Immunosuppressants

Concomitant administration of Trioxal® (Trioxal injection) and cyclosporine or tacrolimus has led to increased plasma concentrations of these immunosuppressants. Concomitant administration of Trioxal® (Trioxal injection) and sirolimus could increase plasma concentrations of sirolimus.

Macrolide Antibiotics

Erythromycin and clarithromycin are known inhibitors of CYP3A4 and may increase plasma concentrations of Trioxal. In a small pharmacokinetic study involving HIV infected patients, clarithromycin was shown to increase plasma concentrations of Trioxal. Similarly, following administration of 1 gram of erythromycin ethyl succinate and 200 mg Trioxal as single doses, the mean Cmax and AUC 0-∞ of Trioxal increased by 44% (90% CI: 119-175%) and 36% (90% CI: 108-171%), respectively.

Oral Hypoglycemic Agents

Severe hypoglycemia has been reported in patients concomitantly receiving azole antifungal agents and oral hypoglycemic agents. Blood glucose concentrations should be carefully monitored when Trioxal® (Trioxal injection) and oral hypoglycemic agents are coadministered.

Polyenes

Prior treatment with Trioxal, like other azoles, may reduce or inhibit the activity of polyenes such as amphotericin B. However, the clinical significance of this drug effect has not been clearly defined.

Protease Inhibitors

Concomitant administration of Trioxal® (Trioxal injection) and protease inhibitors metabolized by CYP3A4, such as indinavir, ritonavir, and saquinavir, may increase plasma concentrations of these protease inhibitors. In addition, concomitant administration of Trioxal® (Trioxal injection) and indinavir and ritonavir (but not saquinavir) may increase plasma concentrations of Trioxal. Caution is advised when Trioxal® (Trioxal injection) and protease inhibitors must be given concomitantly.

Reverse Transcriptase Inhibitors

Nevirapine is an inducer of CYP3A4. In vivo studies have shown that nevirapine induces the metabolism of ketoconazole, significantly reducing the bioavailability of ketoconazole. Studies involving nevirapine and Trioxal have not been conducted. However, because of the similarities between ketoconazole and Trioxal, concomitant administration of Trioxal® (Trioxal injection) and nevirapine is not recommended. In a clinical study, when 8 HIV-infected subjects were treated concomitantly with Trioxal® (Trioxal injection) Capsules 100 mg twice daily and the nucleoside reverse transcriptase inhibitor zidovudine 8 ± 0.4 mg/kg/day, the pharmacokinetics of zidovudine were not affected. Other nucleoside reverse transcriptase inhibitors have not been studied.

Other
  • Levacetylmethadol (levomethadyl) is known to prolong the QT interval and is metabolized by CYP3A4. Co-administration of levacetylmethadol with Trioxal® (Trioxal injection) could result in serious cardiovascular events. Therefore, concomitant administration of Trioxal® (Trioxal injection) and levacetylmethadol is contraindicated.
  • Elevated concentrations of ergot alkaloids can cause ergotism, ie. a risk for vasospasm potentially leading to cerebral ischemia and/or ischemia of the extremities. Concomitant administration of ergot alkaloids such as dihydroergotamine, ergometrine (ergonovine), ergotamine and methylergometrine (methylergonovine) with Trioxal® (Trioxal injection) is contraindicated.
  • Halofantrine has the potential to prolong the QT interval at high plasma concentrations. Caution is advised when Trioxal® (Trioxal injection) and halofantrine are administered concomitantly.
  • In vitro data suggest that alfentanil is metabolized by CYP3A4. Administration with Trioxal® (Trioxal injection) may increase plasma concentrations of alfentanil.
  • Human pharmacokinetic data suggest that concomitant administration of Trioxal® (Trioxal injection) and buspirone results in significant increases in plasma concentrations of buspirone.
  • Trioxal® (Trioxal injection) may inhibit the metabolism of certain glucocorticosteroids such as budesonide, dexamethasone, fluticasone and methylprednisolone.
  • In vitro data suggest that trimetrexate is extensively metabolized by CYP3A4. In vitro animal models have demonstrated that ketoconazole potently inhibits the metabolism of trimetrexate. Although there are no data regarding the effect of Trioxal on trimetrexate metabolism, because of the similarities between ketoconazole and Trioxal, concomitant administration of Trioxal® (Trioxal injection) and trimetrexate may inhibit the metabolism of trimetrexate.
  • Cilostazol and eletriptan are CYP3A4 metabolized drugs that should be used with caution when co-administered with Trioxal® (Trioxal injection).
  • Trioxal® (Trioxal injection) enhances the anticoagulant effect of coumarin-like drugs, such as warfarin.
  • Fentanyl plasma concentrations could be increased or prolonged by concomitant use of Trioxal® (Trioxal injection) and may cause potentially fatal respiratory depression.

Trioxal side effects

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What are the possible side effects of Trioxal?

Interaction Potential: Trioxal oral solution has a potential for clinically important drug interactions. Clinical Trials: Table 1 shows the adverse events reported among patients in clinical trials (pooled data) of Trioxal oral solution compared to fluconazole, in the treatment of oropharyngeal and esopharyngeal candidosis. It includes all adverse events (with an incidence of ≥2%) reported among Trioxal-treated patients. About 44% of patients treated with Trioxal oral solution and about 43% of patients treated with fluconazole experienced at least one adverse event. The adverse events reported are summarized irresponsive of the causality assessment of the investigators.

Post-Marketing Experience: Adverse drug reactions from spontaneous reports during the worldwide post-marketing experience with Trioxal (all formulations) that meet threshold criteria are included in Table 2. The adverse drug reactions are ranked by frequency, using the following convention: Very common ≥1/10, common ≥1/100 and <1/10, uncommon ≥1/1000 and <1/100, rare ≥1/10,000 and <1/1000, very rare <1/10,000, including isolated reports.

The frequency in Table 2 reflect reporting rates for adverse drug reactions from spontaneous reports and do not represent more precise estimates of incidence that might be obtained in clinical or epidemiological studies.

Trioxal contraindications

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What is the most important information I should know about Trioxal?

Drug Interactions

Concomitant administration of Trioxal® (Trioxal) Capsules, Injection, or

Oral Solution and certain drugs metabolized by the cytochrome P450 3A4 isoenzyme system (CYP3A4) may result in increased plasma concentrations of those drugs, leading to potentially serious and/or life-threatening adverse events. Cisapride, oral midazolam, nisoldipine, pimozide, quinidine, dofetilide, triazolam and levacetylmethadol (levomethadyl) are contraindicated with Trioxal® (Trioxal injection). HMG CoA-reductase inhibitors metabolized by CYP3A4, such as lovastatin and simvastatin, are also contraindicated with Trioxal® (Trioxal injection). Ergot alkaloids metabolized by CYP3A4 such as dihydroergotamine, ergometrine (ergonovine), ergotamine and methylergometrine (methylergonovine) are contraindicated with Trioxal®.

Trioxal® (Trioxal injection) is contraindicated for patients who have shown hypersensitivity to Trioxal or its excipients. There is no information regarding cross-hypersensitivity between Trioxal and other azole antifungal agents. Caution should be used when prescribing Trioxal® (Trioxal injection) to patients with hypersensitivity to other azoles.

Trioxal IV cannot be used when administration of Sodium Chloride Injection is contraindicated.

The excipient hydroxypropyl-β-cyclodextrin is eliminated through glomerular filtration. Therefore, Trioxal IV is contraindicated in patients with severe renal impairment (defined as creatinine clearance below 30 mL/min).



Active ingredient matches for Trioxal:

Itraconazole in Poland.


List of Trioxal substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
Traco Gold 100mg Capsule (Kivi Labs Ltd)$ 0.26
Traco Gold 200mg Capsule (Kivi Labs Ltd)$ 0.36
Tracor 100 mg x 20's$ 32.24
TRAX 500MG/50MG INJECTION 1 vial / 2 ML injection each (Divine Savior)$ 0.28
TRAX inj 100 mg x 2 mL x 2ml (Divine Savior)$ 0.29
Trax 500 mg/50 mg Injection (Divine Savior)$ 0.14
10's (Aarush (Corona Remedies Pvt Ltd))$ 0.54
Trazer 150+100+5 Capsule (Aarush (Corona Remedies Pvt Ltd))$ 0.07
Trazer Eicosapentaenoic acid 150 mg, docosahexaenoic acid 100 mg, folic acid 5 mg, mecobalamin750 mcg. S-GEL / 10 (Aarush (Corona Remedies Pvt Ltd))$ 0.66
TRAZER softgel 10's (Aarush (Corona Remedies Pvt Ltd))$ 0.76
Trifungi 100 mg x 1 Blister x 4 Tablet
TRODY cap 100 mg x 4's (Daksh)$ 1.98
Unitrac 100 mg x 3 x 10's (Dankos)
Unitrac 100 mg x 3 x 10's (Dankos)
Unitrac 100 mg x 30's (Dankos)$ 55.18
UNITRAC 0.5MG/25MG TABLET 1 strip / 10 tablets each (Dankos)$ 0.60
Unitrac cap 100 mg 3 x 10's (Dankos)
Unitrac 0.5 mg/25 mg Tablet (Dankos)$ 0.06
Xicone 200mg Capsule (Phoenix Remedies Pvt Ltd)$ 0.34
Capsule; Oral; Itraconazole 100 mg

References

  1. DailyMed. "ITRACONAZOLE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "itraconazole". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "itraconazole". http://www.drugbank.ca/drugs/DB01167 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Trioxal are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Trioxal. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

Consumer reported useful

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Consumer reported price estimates

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1 consumer reported time for results

To what extent do I have to use Trioxal before I begin to see changes in my health conditions?
As part of the reports released by ndrugs.com website users, it takes 5 days and a few days before you notice an improvement in your health conditions.
Please note, it doesn't mean you will start to notice such health improvement in the same time frame as other users. There are many factors to consider, and we implore you to visit your doctor to know how long before you can see improvements in your health while taking Trioxal. To get the time effectiveness of using Trioxal drug by other patients, please click here.
Users%
5 days1
100.0%


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