Commonly Used Anti Fungal Medications, Indications, Dosage, Adverse effects and Drug Interactions

Fungal Diseases are commonly caused and spread through Fungal spores, these are most commonly Localized and can become Systemic often. Fungal Diseases like Candidiasis, Histoplasmosis, Blastomycosis, Coccidioidomycosis (Valley Fever), Cryptococcosis, Aspergillosis, Zygomycosis, Toxoplasmosis are the various types of fungal diseases which show Systemic and Localized Oral features in patients affected by it.

image courtesy www.depts.washington.edu

Fungal infections are most commonly seen in patients who are low in Immunity or Immuno Compromised patients. There are certain Anti Fungal Medications which we are going to share:

Note: This list is just for informative purpose, it should not be used to prescribe medications to any patients or to be taken by any person. Please consult a Doctor before taking any medication Mentioned in the list below. the dosage, trade names etc in this post is regarding Oral Fungal Infections and not for Systemic fungal infections.

List of Antifungal Medications, Generic Name, Trade Name, Indications, Dosage, Side Effects/Adverse Reactions, Drug Interactions:

1. Nystatin:

Generic Name: Nystatin

Trade Name: Nystop, Mycostatin Pastilles, Nilstat Powder and Tablets

Indications: Oral Candidiasis 

Dosage: One or Two Pastilles (200,000-400,000 units) dissolved slowely in mouth 4-5 times daily for 10-14 days

Side Effects/Adverse Reactions: Nausea, Diarrhoea, Vomiting on large excess dosage. 

Drug Interactions: None Known

2. Clotrimazole:

Generic Name: Clotrimazole

Trade Name: Mecelex Oral Troches, Canesten, Lotrimin,

Indications: Oral Candidiasis

Dosage: Dissolve 1 Troche (10 mg) slowely in the mouth, 5 times per day for 10-14 days.

Side Effects/Adverse Reactions: Mild elevations of Liver Enzymes in 15% of patients , Periodic Assessment of liver Funtion in patients with Hepatic Impairment, Nausea, Vomiting.

Drug Interactions: None Known

3. Ketoconazole:

Generic Name: Ketoconozole

Trade Name: Nizoral Tablets

Indications:

• Oral Candidiasis
• Blastomycosis
• Coccidiomycosis
• Histoplasmosis
• Paracoccidioidomycosis
• Histoplasmosis
• Paracoccidioidomycosis

Dosage: Not to be used as initial therapy for Oral candidiasis. 1 Tablet (200 mg) daily for 1-2 weeks for candidiasis. Minimum treatment period for Systemic Mycoses in 6 months.

Side Effects/Adverse Reactions: 

• Serious Hepatotoxicity in 1:10,000 patients
• Monitoring of Liver functionin in indicated for aptients with pre existing hepatic problems, patients who develop symptoms of hepatic  failure or patients treated for >28 days
• Serum Testosterone in lowered
• Nauses, Vomiting
• Anaphylaxis

Drug Interactions: 

• Serious, Life Threatening interactions wuth Terfenadine, Astemizole or Cisapride
• Metabolis mof Cyclosporine, Tacrolimus, Methylprednisolone, Midazolam, Triazolam, Coumarin like drugs, Phenytoin and Rifampin may be altered.

4. Fluconazole:

Generic Name: Fluconazole

Trade Name: Diflucan Tablets

Indications: Oral Candidiasis, Cryptococcal Meningitis

Dosage: For Oral Candidiasis: 2 tablets (200 mg) on Day 1 and 1 tablet (100 mg) daily for 1-2 weeks

Side Effects/Adverse Interactions: Rare cases of Hepatotoxicity, ranging form mild transient elevation of liver enzymes to hepatic failure, Headache, Nausea, Vomiting, Abdominal pain, Diarrhoea.

Drug Interactions: Clinically and potentially significant side effects have been noted with the following, Oral Hypoglycemics, Coumarin like Drugs, Phenytoin, Cyclosporine, Rifampin, Theophylline, Terfenadine, Cispride, Astemizole, Rifabutin and Tacrolimus.

5. Itraconazole:

Generic Name: Sporanox Capsules

Indications:

• Blastomycosis
• Histoplasmosis
• Aspergillosis refractory to Amphotericin B therapy

Dosage:

• For Blastomycosis and Hostoplasmosis: 2 capsules (200mg) daily, increasing by 100 mg increments upto 400 mg daily divided doses if no clinical response is noted.
• For Aspergillosis: 200-400 mg daily
• For life-threatening situations: Loading dose of 200 mg TID for first 3 days, then dose can be reduced.
• Treatment should continue for at least 3 months for all the above

Side Effects / Adverse Effects:

• Rare case of Hepatotoxicity
• Liver Function should be monitored in patients with pre-existing hepatic problems on therapy for more than 1 month
• Nausea, Diarrhoea, Vomiting

Drug Interactions:

• Serious and Life Threatening interactions with terfenadine, astemizole, pimozide, quinidin, oral triazolam, oral midazolam and cispride.
• Lovastatin and Simvastatin should be discontinued
• Increased plasma concentration may be seen with warfarin, ritonavir, indinavir, vinca alkaloids, diazepam, dihydropyridines, cyclosporine, tacrolimus, methyprednisalone, digoxin.

7. Itraconozole:

Generic Name: Itraconozole Solution

Indications: Oral Candidiasis

Dosage:

• 10 ml (100 mg) should be vigorously swished in the mouth and swallowed twice daily for 1-2 weeks

Side Effects / Adverse Effects:

• Rare case of Hepato-toxicity
• Liver function should be monitored in patients with pre existing hepatic problems on therapy for more than 1 month
• Nausea, Diarrhea, Vomiting

Drug Interactions:

• Serious and Life Threatening interactions with terfenadine, astemizole, oral triazolam, oral midazolam and cispride.
• Lovastatin and Simvastatin should be discontinued

Amphotericin B:

Generic Name: Amphotericin B

Trade Name: Fungizone Oral suspension

Indications: Oral Candidiasis

Dosage: 1 ml (100 mg) rinse and hold in mouth for as long as possible, QID, PC and HS for 2 weeks

Side Effects / Adverse Reactions: Rash and Gastrointestinal Symptoms

Drug Interactions: No Significant drug interactions