Antifungals

Published by Bupa’s Health Information Team, November 2011.

This factsheet is for anyone taking antifungals, or who would like information about them.

There are many different fungal infections that can affect the body. Antifungals are used to treat a wide variety of these infections.

Why would I take antifungals?

Antifungal medicines are used to treat fungal infections. These infections are common on your skin, scalp, nails and genitals. Examples include ringworm, fungal nail infection, athlete’s foot and vaginal thrush.

Antifungal medicines can also be used in hospital to treat serious internal fungal infections that can affect organs such as your lungs or brain.

Your doctor may prescribe an antifungal if you have a weakened immune system, such as if you have HIV/AIDS, because you’re more likely to develop fungal infections.

What are the main types of antifungals?

There are many types of antifungals that come in a variety of different forms.

• You can use creams on your skin or for vaginal infections. You can also get sprays and powders to treat skin infections, and nail lacquer for nail infections. You can buy most types from a pharmacy, supermarket or other shops without a prescription from your GP. Antifungal treatments for your skin usually contain a type of antifungal called an imidazole. These include clotrimazole, econazole and ketoconazole.
• You can use tablets to treat vaginal infections that haven’t got better with creams. You can buy antifungals for vaginal infections from a pharmacy without a prescription from your GP. The antifungal medicine used to treat vaginal infections in this way is fluconazole.
• You can also use tablets to treat skin infections that haven’t got better with creams. You may use tablets to treat infections that are difficult to cover with creams, such as those on your scalp or nails. Tablets are also used to prevent infections in people with a weakened immune system. You will probably need a prescription from your GP for these tablets. Antifungal medicines given as tablets include terbinafine, itraconazole and griseofulvin.
• If you have a fungal infection in your mouth or digestive system, lozenges and gels can be used to treat these. They are designed to dissolve slowly in your mouth. Antifungals used to treat mouth infections include miconazole and nystatin. You may need a prescription for some of these medicines.
• Pessaries are commonly used to treat vaginal infections. These are large, solid tablets that you insert into your vagina. They will dissolve and release the medicine into your vagina. You can buy some of these from a pharmacy, but others need to be prescribed by your GP. Pessaries usually include one of the imidazole antifungals.
• You can be given antifungals intravenously (through a drip into a vein in your arm) to treat serious fungal infections of an internal organ. This would be carried out in hospital. Antifungals that can be given in this way include fluconazole, itraconazole, and amphotericin.

How do antifungals work?

Antifungals work in different ways to treat fungal infections. Some of them make holes in the walls of the fungal cells so that the contents of the cells leak out. The cells then die and the infection gradually goes away.

Other antifungals get into the fungal cells and release toxins that stop the cells from growing and multiplying.

How to take antifungals

How you take antifungals will depend on what symptom you’re treating and which type of antifungal you have been given.

Often you will need to continue treating skin infections with creams, sprays and powders for at least a week after the infection has gone. You will need to paint nail lacquers on your nails every day for six months or more to give the new nail time to grow without being reinfected.

You can swallow tablets or capsules whole either with or without food, depending on the type. You need to leave lozenges in your mouth to dissolve for as long as possible and don’t chew or swallow them whole. If you have been given an antifungal oral gel, you can apply this directly to the infection in your mouth. Try to keep the gel in your mouth for as long as possible before swallowing.

When using vaginal pessaries, you will be provided with an applicator that will enable you to insert the pessary high up in your vagina. 

Special care

Some antifungal medicines aren’t recommended for women who are pregnant or breastfeeding. Tell your GP or pharmacist if you’re pregnant or breastfeeding before taking an antifungal medicine.

Some oral gels, such as Daktarin, are designed to be sticky so that they coat your mouth. If you’re giving this medicine to a young child, only place it in the front of his or her mouth and then keep a close watch on the child to ensure he or she doesn’t choke.

Let your GP or pharmacist know if you have ever had kidney, liver or heart problems, or have HIV/AIDS before taking antifungal tablets.

Side-effects of antifungals

Side-effects are the unwanted effects of taking a medicine. If you have side-effects, it’s important to talk to your GP or the healthcare professional who prescribed your medicine before you stop taking it.

This section does not include every possible side-effect of antifungals. Please read the patient information leaflet that comes with your medicine for more information.

The most common side-effects of antifungal tablets include feeling sick, headaches and abdominal (tummy) pain.

One particular antifungal, ketoconazole, is known to cause serious liver problems. This is rare but can be life-threatening. The risk of this happening increases if you’re treated for more than 10 days with this medicine. Tell your GP if you have had liver problems before, whether these were caused by another medicine or for any other reason. If you’re taking ketoconazole, you should seek prompt medical attention if you start to get signs of a liver problem. These include loss of appetite, feeling sick or vomiting, excessive tiredness, abdominal pain, yellowing of the skin (jaundice) or dark urine.

Another antifungal, amphotericin, which is given intravenously, can cause kidney problems. If you’re given this medicine in a hospital, you will have blood tests to monitor the effect it’s having on you.

Other side-effects that you might get with creams, sprays or powders are redness or mild irritation in the places you have used them. If this becomes severe, stop using the medicine and see your GP or pharmacist for advice on alternative treatments.

Allergies

Antifungals can cause allergic reactions in some people. Signs of an allergic reaction include:

• sudden wheezing, tightness in your chest or difficulty breathing
• swollen eyelids, face or lips
• intense itching or reddening of your skin
• a rash, which can sometimes cause blistering of your skin

Stop taking the medicine and tell your GP immediately if you get any of these symptoms.

Interactions of antifungals with other medicines

It’s possible that some antifungals can interfere with how other medicines work. This can change how other medicines are absorbed, making them work faster, slower or not at all. Taking an antifungal alongside other medicines can increase the amount of antifungal in your body. These interactions mean you could risk having more side-effects or unexpected reactions to your current medicines or the antifungal. Talk to your GP or pharmacist about any other medicines you’re taking before you start taking an antifungal. This includes any herbal remedies or over-the-counter medicines, as well as those you have on prescription.

Names of common antifungals

Names of antifungal medicines are shown in the table below. All medicines have a generic name. Many medicines also have one or more brand name. Generic names are in lower case, whereas brand names start with a capital letter.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.