Antifungal Medications
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| Prevent the synthesis of ergosterol, building block for fungal cell membranes, act by inhibiting fungal cytochrome P-450 | Antifungal agents
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| Pulse dosing | usually one week per month
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| Polyenes, Azoles, Echinocandins | Classes of antifungal drugs
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| clotrimazole | Mycelex
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| nystatin | Mycostatin
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| clotrimazole and nystatin | Used to treat oral thrush agents
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| used to treat skin and nail agents | butenafine, ciclopirox, clotrimazole, clotrimazole-betamethasone, griseofulvin, ketoconazole
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| butenafine | Lotrimin Ultra, Mentax
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| ciclopirox | Loprox, Penlac
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| clotrimazole | Desenex, Lotrimin AF
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| clotrimazole-betamethasone | Lotrisone
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| griseofulvin | Grifulvin V, Gris-PEG
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| ketoconazole | Nizoral
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| miconazole | Micatin, Neosporin AF
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| nystatin | Nyamyc, Nystop
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| terbinafine | Lamisil AT
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| used to treat systemic agents | amphotericin B, caspofungin, fluconazole, flucytosine, itraconazole, ketoconazole, liposomal amphotericin B, micafingin, posaconazole, voriconazole
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| caspofungin | Cancidas
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| fluconazole | Diflucan
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| flucytosine | Ancobon
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| itraconazole | Sporanox
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| ketoconazole | Nizoral
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| liposomal amphotericin B | Abelcet, Amphotec, AmBisome
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| micafungin | Mycamine
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| posaconazole | Noxafil
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| voriconazole | Vfend
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| used to treat vaginal agents | butoconazole, clotrimazole, miconazole, tioconazole
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| butoconazole | Gynazole-1
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| clotrimazole | Gyne-Lotrimin
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| miconazole | Monistat
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| tioconazole | Vagistat-1
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| Which antifungals can be OTC for skin and nail agents | butenafine (Lotrimin Ultra), clotrimazole (Desenex, Lotrimin AF), miconazole (Micatin, Neosporin AF), terbinafine (Lamisil AT)
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| Which antifungals are by RX only for vaginal agents (also has OTC version) | butoconazole (Gynazole-1)
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| All systemic agent antifungals are | by RX only
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| Which antifungal systemic agents come in injectable dosage form | amphotericin B, caspofungin, fluconazole, liposomal, micafungin, posaconazole, voriconazole
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| Reports of anaphylaxis occurrence | amphotericin B
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| drug interactions with Polyenes | Amphotericin should not be used with foscarnet. Nystatin diminishes effects of probiotic Saccharomyces boulardii
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| Common Polyenes | amphotericin B and nystatin
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| Common Azoles | clotrimazole (Mycelex), ketoconazole (Nizoral), fluconazole (Diflucan), itraconazole (Sporanox), posaconazole (Noxafil), voriconazole (Vfend)
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| Common side effects of azoles | orally: nausea, vomiting, abdominal pain, diarrhea
topically: burning, discomfort, edema, pain
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| associated with transient vision changes, visual hallucinations, alopecia, nail changes or loss, skin rash | voriconazole
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| should be taken with acidic food or drink, to improve absorption | itraconazole capsules
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| should be taken with food | posaconazole
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| Contraindications of azoles | concurrent use of quinidine, benzodiazepines, statins
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| contraindicated in patients with milk protein allergy | miconazole
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| black box warning for hepatotoxicity and QT prolongation | ketoconazole
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| comes with 2 different box warnings : multiple drug cautions | itraconazole
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| caspfungin and micafungin | echinocandin class of antifungals
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| work by inhibiting the synthesis of D-glucan, which is integral component of the fungal cell wall | echinocandins
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| caspofungin | Cancidas
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| micafungin | Mycamine
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| used to treat Aspergillosis and Candida | caspofungin and micafungin
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| only available in IV form, for treatment of invasive Aspergillosis and Candida in patients unresponsive to other therapies | caspofungin
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| associated with anaphylaxis and histamine related reactions | echinocandins
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| drug interactions with echinocandins | cyclosporine, Rifampin, pimozide, decreases activity of probiotic Saccharomyces boulardii
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| should not use if pregnant or have liver failure or porphyria | griseofulvin
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| black box warning to use with extreme caution in patients w/ renal dysfunction | flucytosine
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| echinacea and zinc | alternative therapy for some fungal and some bacterial infections
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