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Antifungal medicines Content Supplied by NHS Choices
Introduction

Antifungal medicines are used to treat fungal infections, which are most commonly found on the skin, hair and nails.

You may be given an antifungal medicine to treat common fungal infections, such as:

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

Invasive fungal infections

Invasive fungal infections are less common but more serious. They are infections that occur deep inside the body's tissue or in one of the internal organs. Invasive fungal infections can affect the:

  • lungs - for example, aspergillosis, where a fungus called aspergillus infects the lining of the lungs
  • brain - for example, fungal meningitis, where a fungus infects the protective membranes surrounding the brain and spinal cord

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 chemotherapy to treat cancer
  • people who are taking medicines to suppress the immune system, such as corticosteroids; in particular, people who have had an organ transplant will be taking immunosuppressants, making them more vulnerable to fungal infections

How antifungal medicines work

Antifungal medicines work by either:

  • killing the fungal cells - for example, by affecting a substance in the cell walls, causing the contents of the fungal cells to leak out and the cells to die
  • preventing the fungal cells from growing and reproducing

Types of antifungal medicines

Antifungal medicines are used in several ways, depending on your specific fungal infection. The main types of antifungal medicines include:

  • topical antifungals - applied directly to the skin, hair or nails
  • oral antifungals - which are swallowed in capsule, pill or liquid form
  • intravenous antifungals - which are injected into your bloodstream
  • intravaginal antifungal pessaries - small, soft tablets inserted into the vagina to treat conditions such as vaginal thrush

Commonly used antifungal medicines

There are many different types of antifungal medicines, and you may be familiar with some of the advertised brand names. Many of these brands will contain the same generic antifungal ingredients (alone or in combination). Some of the most common include:

  • clotrimazole
  • econazole
  • miconazole
  • terbinafine
  • fluconazole
  • ketoconazole
  • amphotericin

The packaging should say which antifungal medicine the product contains. It should also say how strong the antifungal medicine is, usually shown as a percentage of the product or in milligrams - for example, "cream containing 1% clotrimazole" or "capsules containing 50mg of fluconazole".

Getting the right dose of antifungal treatment

Your GP or pharmacist should advise on how to take or use your antifungal medicine. The patient information leaflet that comes with your medicine will also contain advice on using your medicine.

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 medicine's packaging with you so the healthcare professionals who treat you know what you have taken.

Antifungal medicines for children

Some antifungal medicines can be used on children and babies. For example, miconazole oral gel can be used to treat oral thrush in babies.

Check the patient information leaflet that comes with your medicine to see if it's suitable for children, or ask your pharmacy. Different doses are usually needed for children of different ages.

Taking antifungal drugs

Before taking antifungal medicines, you should consider:

You can discuss allergies, side effects and your existing health problems with the pharmacist dispensing your medicine or, if applicable, the doctor who prescribed it.

Names of antifungal medicines

Antifungal medicines have many brand names, as they are made by different pharmaceutical manufacturers.

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 shown 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 - a cream, gel, ointment or spray applied directly to the body
  • oral antifungals - a capsule, tablet or liquid medicine that is swallowed
  • intravenous antifungals - an injection 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 suppositories inserted into the vagina to treat conditions such as vaginal thrush.

Things to consider when using antifungal medicines

Before you take antifungals, there are a number of things you should discuss with your GP.

Allergies

You are generally advised not to take an antifungal medicine if you are allergic to the medicine or any of its ingredients.

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

Other conditions

If you have problems with your heart, liver or kidneys, be careful using some oral antifungals.

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

Topical antifungals

If you are using a topical antifungal medicine, such as a cream, it should not come into contact with:

  • your eyes
  • moist linings (mucous membranes) - 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 vaginal suppositories (pessaries) are sometimes used to treat thrush.

However, these types of antifungal medicines can damage latex condoms and diaphragms, making them less effective. If you need to use these types of medication, either 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. You can find out if yours is suitable by checking the patient information leaflet that comes with your medicine.

However, if you have vaginal thrush during pregnancy, your GP may prescribe an antifungal suppository that can be inserted into your vagina (a pessary) or an antifungal cream.

Breastfeeding

Small amounts of some medicines can pass into your breast milk, which 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.

Side effects of antifungal medicines and interactions with other medicines

Antifungal medicines can cause side effects. These will differ depending on the type of antifungal medicine you are using.

Side effects of topical antifungals

Topical antifungal medicines, such as creams, can cause:

  • itching
  • a mild burning sensation
  • redness

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

Side effects of oral antifungals

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

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

Antifungals can also cause severe reactions, such as:

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

If you experience any of these reactions, stop taking your medicine and contact your GP immediately.

If you are having difficulty breathing, visit the accident and emergency (A&E) department of your nearest hospital or call 999 for an ambulance.

Liver damage from antifungal medicines

Liver damage is a rare, but more serious, side effect of oral antifungals.

Stop taking the medicine and contact your GP if you experience:

  • 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

Side effects of intravenous antifungals

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

More rarely it can cause problems with your:

  • heart - causing an irregular heartbeat or changes in your blood pressure
  • liver - affecting the way your liver functions by, 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

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

Antifungal medicine interactions with other medicines

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 interaction. Some antifungal medicines can interact with other medicines.

Tell your GP or pharmacist what other medicines you are taking, including over-the-counter medicines, so 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 used to treat indigestion
  • hydrochlorothiazide - a medicine used to treat high blood pressure (hypertension)
  • oestrogens and progestogens - hormones found in some contraceptives
  • phenytoin - a medicine used to treat epilepsy
  • rifampicin - an antibiotic used to treat bacterial infections, such as tuberculosis
  • cyclosporine and tacrolimus - medicines that suppress the immune system
  • theophylline - a medicine used to treat asthma
  • tricyclic antidepressants - medicines used to treat depression
  • zidovudine - a medicine used to treat HIV and AIDS
 
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