I, "Azole" antifungals
- Side f/x: Neutropenia, thrombocytopenia [Cr] (all
frequent), rash, n/v, anemia, OT, A-phos, T.
- Contraindications: Concurrent tx with Phenytoin,
barbiturates, rifampin, corticoids, cytotoxic
chemo; elevated LFTs, A-phos, bili, or Cr;low
PMNs or platelets?
- H2-blockers & antacids--simultaneous
- Rifampin, phenytoin alter levels
- Carbamazepine and Barbiturates accelerate
metab or absorp.
- Other significant interaction:
- Can cause hepatotoxicity and problematic
interactions with other drugs)
- Voriconazole--Unlike other -azoles, shows promise against
- Posaconazole, a broad-spectrum antifungal.
- Ravuconazole, a broad-spectrum antifungal, in clinical trials as of
- Can cause HA, nausea, and abd. discomfort
III. Allylamines, i.e. Terbinafine
- Can cause headache, diarrhea, dyspepsia, abd. pain,
and taste disturbance that may persist for weeks
after drug is stopped.
- Rarely can cause serious hepatotoxicity.
- Doesn't have serious interactions with other drugs,
e.g. terfenadine, dig, warfarin. (Med. Letter 38: 72,
- Usually used systemically only for life-threatening
- Highly toxic, IV complications
- 2/3 get bacteremia, catheter inf., or
- Block synthesis of fungal cell wall
- Require IV infusion
- Active against Aspergillus and Candida
- Caspofungin (Cancidas)
- Can cause fever, rash, nausea, vomiting, and phlebitis at the
- May be teratogenic
- Micafungin (Mycamine)
- Anidulafungin (Eraxis)