ANTIFUNGALS


I, "Azole" antifungals

  1. Itraconazole
  1. Side f/x: Neutropenia, thrombocytopenia [Cr] (all frequent), rash, n/v, anemia, OT, A-phos, T. bili; [K]
  2. Contraindications: Concurrent tx with Phenytoin, barbiturates, rifampin, corticoids, cytotoxic chemo; elevated LFTs, A-phos, bili, or Cr;low PMNs or platelets?
  3. Interactions
    1. H2-blockers & antacids--simultaneous administrationimpede absorption
    2. Rifampin, phenytoin alter levels
    3. Carbamazepine and Barbiturates accelerate metab or absorp.
    4. Other significant interaction: erythromycin, cisapride
  1. Ketaconazole
    1. Can cause hepatotoxicity and problematic interactions with other drugs)
  2. Fluconazole
  3. Clotrimazole
  4. Miconazole
  5. Voriconazole--Unlike other -azoles, shows promise against Aspergillus sp.
  6. Posaconazole, a broad-spectrum antifungal.
  7. Ravuconazole, a broad-spectrum antifungal, in clinical trials as of 2006.

II. Griseofulvin

  1. Can cause HA, nausea, and abd. discomfort

III. Allylamines, i.e. Terbinafine

  1. Can cause headache, diarrhea, dyspepsia, abd. pain, and taste disturbance that may persist for weeks after drug is stopped.
  2. Rarely can cause serious hepatotoxicity.
  3. Doesn't have serious interactions with other drugs, e.g. terfenadine, dig, warfarin. (Med. Letter 38: 72, 1996)

IV. Amphotericin

  1. Usually used systemically only for life-threatening fungal infections
  2. Highly toxic, IV complications
  3. 2/3 get bacteremia, catheter inf., or thrombophlebitis

V. Echinocandins

  1. Block synthesis of fungal cell wall
  2. Require IV infusion
  3. Active against Aspergillus and Candida
  4. Caspofungin (Cancidas)
    1. Can cause fever, rash, nausea, vomiting, and phlebitis at the injection site
    2. May be teratogenic
  1. Micafungin (Mycamine)
  2. Anidulafungin (Eraxis)
  3. Aminocandin