Antifungal medicines

Page last reviewed: 13/07/2011

Antifungal medicines are used to treat fungal infections.

Fungal infections

Fungi are plant-like organisms but, unlike plants, they cannot turn sunlight into food (photosynthesis). To feed, fungi have to break down living tissue instead, which includes human tissue.

Fungi that cause infections in humans are known as dermatophytes. Dermatophytes are particularly attracted to a type of tissue called keratin, which is a tough, waterproof tissue that can be found in many parts of the body such as in the:

  • nails
  • hair
  • skin's outer surface

This explains why fungal infections often occur on the skin, nails and scalp.

Common fungal infections

Antifungal medicines may be used to treat the following common fungal infections:

  • ringworm- a skin infection that causes a ring-like red rash on the skin of the body or scalp
  • athlete's foot - an infection that affects the skin on the feet, causing it to become red, flaky and itchy
  • fungal nail infection- a condition that causes the toenails or fingernails to become thickened and discoloured, and sometimes brittle, with pieces of nail breaking off
  • vaginal thrush - a condition that causes irritation and swelling of the vagina and vulva (a woman's external sexual organs)

Invasive fungal infections

Invasive fungal infections are a less common, but more serious, type of fungal infection. They are infections that occur deep inside the body's tissue or in one of the organs, such as in the:

  • brain - for example, fungal meningitis,where a fungus causes an infection of the protective membranes that surround the brain and spinal cord
  • lungs - for example, aspergillosis, which is a lung infection that is caused by a fungal mould called aspergillus

People with a weakened immune system (the body's natural defence system) are particularly vulnerable to invasive fungal infections. Those at risk include:

 

  • people with HIV and AIDS
  • people having high-dose chemotherapyto treat cancer
  • people who are taking immunosuppresants - medicines to suppress the immune system (the body's natural defence against infection and illness)

How it works

Antifungal medicines work by either:

  • killing the fungal cells - for 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

Use in children

Some antifungal medicines can be used in children and babies. For example, miconazole can be used to treat oral thrush in babies who are four months old or over.

Check the patient information leaflet that comes with your medicine to see if it is suitable for children. Different doses may be needed for children of different ages.

A white blood cell destroying a thrush fungus. Antifungal medicines are used to treat fungal infections such as thrush. 

Page last reviewed: 13/07/2011

Antifungal medicines are made by many different pharmaceutical manufacturers, with each giving their product a different brand name. 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 product contains and how much. This may be as a percentage - for 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 antifungals - topical is a general term that describes any sort of cream, gel, ointment or spray that is applied directly to the affected body part
  • oral antifungals - any type of medicine that you swallow, such as capsules, tablets or an oral suspension (liquid medicine) 
  • intravenous antifungals - antifungal medicines that are injected 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. Pessaries are small, solid preparations of medicine that a woman can insert into her vagina to treat conditions such as vaginal thrush.

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Page last reviewed: 13/07/2011

You are generally advised not to take an antifungal medicine if you are allergic to the medicine or to any of the ingredients that are used in it.

In some cases, such as when treating invasive fungal infections in hospital, your doctors may feel that the benefit of the medicine outweighs the risk of an allergic reaction. They may decide to use the medicine and monitor you closely.

Use antifungals with caution

Be careful with some oral antifungals if you have:

  • problems with your heart 
  • problems with your liver
  • problems with your kidneys

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

See the patient information leaflet that comes with your medicine to find out when caution should be used before taking a specific type of antifungal medicine.

Topical antifungals

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

  • your eyes 
  • mucous membranes (moist linings), 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 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 are found in some types of hormonal contraceptives, such as the combined 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 have vaginal thrush during pregnancy, your GP may prescribe an antifungal treatment that can be inserted into your vagina (an intravaginal pessary) or an antifungal cream.

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.

Heart
The heart is a muscular organ that pumps blood around the body.
Kidneys
The kidneys are two bean-shaped organs that are located on either side of the body, just underneath the ribcage, that filter out waste products from the blood.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and turn food into energy.

Page last reviewed: 13/07/2011

Antifungal medicines can cause side effects. These will differ depending on which type of antifungal medicine you are using. See the patient information leaflet that comes with your medicine, for information about the side effects of specific type of antifungal medicine.

Topical antifungals

Topical antifungal medicines, such as creams, can cause:

  • irritation
  • a mild burning sensation
  • itching
  • redness

Stop using the medicine if any of these side effects are severe and see your GP or pharmacist to find an alternative.

Oral antifungals

Side effects of oral antifungals, such as capsules, include:

  • feeling sick
  • abdominal (tummy) pain
  • diarrhoea
  • flatulence (wind)
  • headache
  • a rash
  • indigestion

These side effects are usually mild and only last for a short period of time.

If you experience any of the following reactions, stop taking your medicine and contact your GP immediately:

  • an allergic reaction - swelling of your face, neck or tongue or difficulty breathing
  • a severe skin reaction - such as peeling or blistering skin

Liver damage

Liver damage is a rare, but potentially more serious, side effect of oral antifungals. If you experience the symptoms listed below, stop taking your medicine and contact your GP because they may be caused by damage to your liver:

  • loss of appetite
  • vomiting
  • feeling sick for a long time
  • jaundice- yellowing of your skin or the whites of your eyes 
  • unusually dark urine or pale faeces (stools)
  • unusual tiredness or weakness

Intravenous antifungals

Amphotericin (amphotericin B) is the most commonly used intravenous antifungal. This is usually given in hospital as an intravenous infusion (a continuous drip of medicine into a vein in your arm). Side effects of amphotericin include:

  • loss of appetite 
  • feeling sick
  • vomiting
  • diarrhoea
  • epigastric pain (pain in the upper part of your tummy)
  • a high temperature (fever)
  • chills
  • headache 
  • muscle and joint pain
  • anaemia (a reduced number of red blood cells)
  • a rash

Amphotericin can also affect your:

  • kidneys - causing abnormally low levels of some minerals in your blood, such as potassium or magnesium  
  • heart - causing an irregular heartbeat or changes in your blood pressure
  • liver - affecting the way that your liver functions, for example, causing a build-up of bilirubin in the blood; bilirubin is a yellow substance that is produced when red blood cells are broken down  
  • nervous system - your brain, nerves and spinal cord, causing conditions such as hearing loss or peripheral neuropathy

As amphotericin is given in hospital under supervision, any adverse effects are usually quickly detected and treated.

Heart
The heart is a muscular organ that pumps blood around the body.
Kidneys
The kidneys are two bean-shaped organs that are located on either side of the body, just underneath the ribcage, that filter out waste products from the blood.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and turn food into energy.

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Reporting side effects 

You can report suspected side effects from any type of medicine that you are taking on the Irish Medicines Board website www.imb.ie

Page last reviewed: 13/07/2011

When two or more medicines are taken at the same time, the effects of one of the medicines can be altered by the other. This is known as a drug-drug interaction. Some types of antifungal medicines can interact with other medicines.

Tell your GP or pharmacist what other medicines you are taking, including over-the-counter medicines, so that they can decide whether an antifungal medicine is safe for you to take.

Medicines that antifungal medicines may interact with include:

  • benzodiazepines - a group of medicines used to help sleep and reduce anxiety
  • ciclosporin - a medicine that suppresses the immune system (the body's natural defence against illness and infection)
  • cimetidine - a medicine that is used to treat indigestion
  • hydrochlorothiazide - a medicine that is used to treat  high blood pressure (hypertension) 
  • oestrogens - hormones that are found in some contraceptives
  • phenytoin - a medicine that is used to treat epilepsy
  • progestogens - hormones that are found in some contraceptives
  • rifampicin - an antibiotic that is used to treat bacterial infections, such as tuberculosis 
  • tacrolimus - a medicine that suppresses the immune system
  • theophylline - a medicine that is used to treat asthma
  • tricyclic antidepressants - medicines that are used to treat depression
  • zidovudine - a medicine that is used to treat HIV and AIDS

The above list only includes some examples. See the patient information leaflet that comes with your antifungal medicine.

Interactions with food and alcohol

For most antifungal medicines, there are no known interactions with moderate alcohol intake or with specific foods

Page last reviewed: 13/07/2011

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

Missed doses

If you miss a dose of antifungal medicine, check the patient information leaflet that comes with it to see what action is advised. You may need to take the missed dose as soon as you remember and the next dose at the normal time.

Extra doses

Speak to your GP or pharmacist if you take too much of your antifungal medicine. You may be advised to visit your nearest hospital's accident and emergency (A&E) department. If you are advised to go to hospital, take the medication's packaging with you so that the healthcare professionals who treat you know what you have taken.

Further advice

If you need further advice about missed or extra doses of antifungal medicines you can contact your GP or your pharmacist.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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