antifungal medicines

8/12/2019 Antifungal Medicines

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Table 1

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Options for Treatment of Superficial Fungal Infections*

Drugs Formulations Uses

Allylamines

Amorolfine 5% solution Tinea unguium

Naftifine 1% cream or gel Dermatophytoses, skin

candidiasis

Terbinafine Topical: 1% cream or solution Dermatophytoses

Oral: 250-mg tablet

Benzylamine

Butenafine 1% cream Dermatophytoses

Imidazoles

Butoconazole 2% cream Vulvovaginal candidiasis

Clotrimazole Topical: 1% cream, lotion, or

solution; 100-, 200-, and 500-

mg vaginal suppository tablets

Dermatophytoses,

candidiasis

(oropharyngeal, skin,

vulvovaginal)

Oral: 10-mg lozenges

Econazole 1% cream Dermatophytoses, skin

candidiasis, tinea


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versicolor

Fluconazole 50 and 200 mg/5 mL solution;

50-, 100-, 150-, and 200-mg

tablets

Candidiasis

(vulvovaginal, skin,

oropharyngeal)

Itraconazole 100-mg capsules, 10 mg/mL

solution

Tinea unguium, other

onychomycoses

Ketoconazole 2% cream, 1 to 2% shampoo,

200-mg tablet

Dermatophytoses, skin

candidiasis

Miconazole 1 to 2% liquid (aerosol), 2%

powder (aerosol), 1 to 2%

cream and lotion, 1% solution,

2% powder or tincture, 100- or

200-mg vaginal suppositories

Dermatophytoses,

candidiasis (skin,

vulvovaginal)

Oxiconazole 1% cream or lotion Dermatophytoses, tinea

versicolor

Sulconazole 1% cream or solution Dermatophytoses, tinea

versicolor

Terconazole 0.4% and 0.8% cream, 80-mg

suppositories

Vulvovaginal candidiasis

Tioconazole 6.5% ointment Vulvovaginal candidiasis


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Polyene

Nystatin Topical: 100,000 U/g cream,

ointment, powder, or vaginal

tablet

Candidiasis

(oropharyngeal, skin)

Oral: 100,000 U/mL

suspension, 500,000-U tablets

Miscellaneous

Carbolfuchsin Solution Chronic

dermatophytoses,

intertrigo

Ciclopirox 0.77% gel, 8% lacquer solution Dermatophytoses,

candidiasis, tinea

versicolor,

onychomycosis

Clioquinol 3% cream Dermatophytoses

Gentian violet 1 or 2% solution Dermatophytoses,

especially tinea pedis;

sometimes candidiasis

Griseofulvin 125-, 165-, 250-, 330-, and 500-

mg tablets

Dermatophytoses

Tolnaftate 1% liquid, powder, liquid or

aerosol spray, cream, or

solution

Dermatophytoses, tinea

versicolor

Zinc


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Undecylenate/undecylenate

acid

25% solution, 10% tincture Superficial

dermatophyte

infections (eg, tinea

pedis)

*Advantages of one topical drug over another for most infections are not clear. For skin infections,allylamines have good activity against dermatophytes but weaker activity against Candida;imidazoleshave better activity against both dermatophytes and Candida. Adverse effects are rare, but all topicalantifungals can cause skin irritation, burning, and contact dermatitis. Drug doses may vary by indication.Oral antifungals can cause hepatitis and neutropenia. Periodic laboratory monitoring of hepatic functionand of CBC is recommended when oral antifungals (eg, itraconazole

, terbinafine

) are given for > 1 mo.Drug interactions may occur. For example, itraconazole

may interact with lovastatin

,midazolam

, simvastatin

, and triazolam

. Cisapride

, dofetilide

, pimozide

, orquinidine

should not be used with itraconazole

; taking these drugs with itraconazole

may cause cardiac arrhythmias.


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Antifungal medicines have many brand names as they aremade by different pharmaceutical manufacturers.There are also many different types of antifungal medicines,including:

clotrimazole

econazole nitrate

miconazole

terbinafine

fluconazole

ketoconazole

amphotericin

The packaging should state what antifungal medicine the productcontains and how much. This may be shown as a percentagefor example, cream containing 1% clotrimazole, or in milligrams(mg)for example, capsules containing 50mg of fluconazole.

Types of antifungal medicines

Antifungal medicines are available as: topical antifungalsa cream, gel, ointment or spray applied directly to the body

oral antifungalsa capsule, tablet or liquid medicine that is swallowed intravenous antifungalsan injection into a vein in your arm, usually in hospital

through an intravenous infusion (a continuous drip of medicine through a narrow

tube)

Antifungal intravaginal pessaries are also available. Pessariesare small suppositories inserted into the vagina to treat conditionssuch asvaginal thrush.
http://www.nhs.uk/Conditions/Thrush/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Thrush/Pages/Introduction.aspx


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Things to consider when using

antifungal medicinesBefore you take antifungals there are a number of things you should discuss with your GP.

Allergies

You are generally advised not to take an antifungal medicine if you are allergic to the medicine or any

of the ingredients used in it.

In some cases, such as when treating invasive fungal infections in hospital, your doctors may feel the

benefit of the medicine outweighs the risk of an allergic reaction. They may decide to use the

medicine and monitor you closely.

Other conditions

Be careful with some oral antifungals if you have problems with your heart, liver or kidneys.

Discuss your condition with your GP or pharmacist to find out which antifungal medicines are safe for

you to use.

Topical antifungals

If you are using a topical antifungal medicine, such as a cream, avoid it coming into contact with:

your eyes

moist linings (mucous membranes), for example, inside your nose or mouth (unless it

is a gel that is supposed to be used in your mouth)

Contraceptives

Some antifungal medicines are designed to be used on a man's penis or in or around a woman's

vagina. Antifungal creams or vaginal suppositories (pessaries) are sometimes used to treat thrush.

However, these types of antifungal medicines can damage latex condoms and diaphragms, making

them less effective. Use a different method of contraception while you are using the antifungal

medicine, or avoid having sex.

Some types of antifungal medicines can also interact with oestrogens and progestogens, which arefound in some types of hormonal contraceptives, such as thecombined contraceptive pill.You may

experience some breakthrough bleeding while taking your antifungal medicine, but your contraceptive

protection should not be affected.

Only oral antifungal medicines interact with oestrogens.

Pregnancy

Many antifungal medicines are not suitable to take during pregnancy. Check the patient information

leaflet that comes with your medicine to find out.

However, if you havevaginal thrush during pregnancy, your GP may prescribe an antifungalsuppository that can be inserted into your vagina (a pessary) or an antifungal cream.
http://www.nhs.uk/conditions/Combined-contraceptive-pill/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Thrush/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Thrush/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Combined-contraceptive-pill/Pages/Introduction.aspx


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Breastfeeding

Small amounts of some medicines can pass into your breast milk and may then be passed on to your

baby if you are breastfeeding. Check the patient information leaflet that comes with your antifungal

medicine, as many medicines should not be taken while breastfeeding.

Antifungal medicines are used to treat fungal infections.

Fungal infections

Fungi are plant-like organisms that feed by breaking down livingtissue.Fungi that cause infections in humans are known asdermatophytes. Dermatophytes are particularly attracted to a typeof tissue called keratin, which is a tough, waterproof tissue foundin many parts of the body such as in the:

nails

hair

skins outer surface

This explains why fungal infections often occur on the skin, nailsand scalp.Common funga l in fec tions

Antifungal medicines may be used to treat the following common

fungal infections: ringwormwhich causes a ring-like red rash on the skin of the body or scalp

athletes footwhich affects the skin on the feet, causing it to become red, flaky and

itchy

fungal nail infectionwhich causes the toenails or fingernails to become thickened

and discoloured, and sometimes brittle, with pieces of nail breaking off

vaginal thrushwhich causes irritation and swelling of the vagina and vulva (the

female external sexual organs)
http://www.nhs.uk/conditions/Ringworm/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Athletes-foot/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Athletes-foot/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Fungal-nail-infection/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Thrush/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Thrush/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Fungal-nail-infection/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Athletes-foot/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Ringworm/Pages/Introduction.aspx


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Invasiv e fung al infect ion s

Invasive fungal infections are a less common, but more serious,type of fungal infection. They are infections that occur deep inside

the bodys tissue or in one of the organs, such as in the: brain for example, fungalmeningitis,where a fungus causes an infection of the

protective membranes that surround the brain and spinal cord

lungsfor example,aspergillosis,which is a lung infection caused by a fungal mould

called aspergillus

People with a weakened immune system (the bodys naturaldefence system) are particularly vulnerable to invasive fungalinfections. Those at risk include:

people withHIV and AIDS

people having high-dosechemotherapy to treat cancer

people who are taking immunosuppresantsmedicines to suppress the immune

system (the bodys natural defence against infection and illness), often used after an

organ transplant

How antifungal medicines work

Antifungal medicines work by either:

killing the fungal cellsfor example, by affecting a substance in the cell wall, causing

the contents of the cell to leak out and the cell to die

preventing the fungal cells from growing and reproducing

Types of antifungal medicines

Antifungal medicines are used in several ways, depending onyour specific fungal infection. The main types of antifungalmedicines include:

topical antifungals, applied to the skin, hair or nails

oral antifungals, swallowed in capsule, pill or liquid form

intravenous antifungals, injected into your bloodstream

Read more about thetypes of antifungal medicines.

Things to consider

Before taking antifungal medicines, there are various things toconsider, such as any existing conditions or allergies that mayaffect your treatment for fungal infection.Read more aboutspecial considerations for antifungal medicines.
http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Aspergillosis/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/HIV/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/chemotherapy/pages/definition.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/What-is-it-used-for.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/considerations.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/considerations.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/What-is-it-used-for.aspxhttp://www.nhs.uk/conditions/chemotherapy/pages/definition.aspxhttp://www.nhs.uk/conditions/HIV/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Aspergillosis/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx


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Side effects

As with all medicines, antifungal medicines have side effects.These depend on the type of medication you're taking. In most

cases, the side effects are mild and only last a short time, butthere are rare cases of more serious problems.Common side effects include:

irritation of the skin

diarrhoea

feeling sick

indigestion

In rare cases, liver damage can occur as a result of using

antifungal medicines.Read more about theside effects of antifungal medicines.

Interactions with other medicines

When two or more medicines are taken at the same time, theycan sometimes affect how each other works, this is known asinteraction.There are several medicines that can interact with antifungal

medicines.Read more aboutmedicines that can interact with antifungalmedicines.

Dosage

Your GP or pharmacist should advise on how to take or use yourantifungal medicine. For further information, see the patientinformation leaflet that comes with your medicine or the

Medicines information tab above.Speak to your GP or pharmacist if you take too much of yourantifungal medicine. You may be advised to visit your nearesthospitals accident and emergency (A&E) department. If you areadvised to go to hospital, take the medications packaging withyou so that the healthcare professionals who treat you know whatyou have taken.
http://www.nhs.uk/conditions/diarrhoea/pages/introduction.aspxhttp://www.nhs.uk/conditions/indigestion/pages/introduction.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/Side-effects.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/interactions.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/interactions.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/interactions.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/interactions.aspxhttp://www.nhs.uk/Conditions/Antifungal-drugs/Pages/Side-effects.aspxhttp://www.nhs.uk/conditions/indigestion/pages/introduction.aspxhttp://www.nhs.uk/conditions/diarrhoea/pages/introduction.aspx

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