Drugs for treatment of fungal infections

Article Abstract:

Opportunistic fungal infections (which take advantage of decreased immunity) are on the increase, particularly in patients suffering from AIDS and those who are taking immunosuppressive drugs or are in intensive care units. Four drugs are currently in use to treat deep fungal infections today. They are amphotericin B, flucytosine, ketoconazole, and fluconazole. Amphotericin B may cause an acute reaction including fever, shivering, hypotension, and rapid breathing. This reaction is most severe with the first doses of the drug, and can be reduced with by aspirin or acetaminophen and hydrocortisone. Amphotericin B often also causes nephrotoxicity (kidney damage). Hypokalemia (low blood potassium) may also occur and require treatment. Other common side effects include headache, nausea, vomiting, and anemia. Because resistance to flucytosine develops quickly, it is almost always given with amphotericin B, but as a consequence, toxicity frequently occurs. Ketoconazole is less toxic than amphotericin B, but it less effective for certain fungal infections. Anorexia (loss of appetite), nausea, or vomiting are common side effects; taking the drug with food or at bedtime sometimes helps. Pruritus (itching), rash and dizziness may also occur as can mild to serious hepatic (liver) toxicity. Fluconazole is very expensive and is only effective for a few fungal infections. Most of the side effects are mild; gastrointestinal distress is common but therapy can usually continue. While drug interactions can occur with amphotericin B (and flucytosine given with it), serious drug interactions may take place with ketoconazole. It is poorly absorbed in the absence of gastric acid, and is not advisable in patients taking drugs to inhibit acid formation or antacids. Using rifampin and ketoconazole together decreases the effects of both drugs; it may increase the effect of oral anticoagulants (blood thinners) and the toxicity of cyclosporine and corticosteroids. Using phenytoin (an anticonvulsant) and ketoconazole together may change the blood concentration of either or both drug. If alcohol is taken, a disulfiram-like reaction can occur. (Disulfiram is a drug used to treat alcoholics; it causes a severe reaction.) High doses of fluconazole may increase the toxicity of phenytoin and cyclosporine and add to the effect of the anticoagulant warfarin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Drug interactions

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Itraconazole

Article Abstract:

The Food and Drug Administration has approved the use of itraconazole to treat the fungal infections blastomycosis and histoplasmosis. Sold under the brand name Sporanox by Janssen Pharmaceutica, itraconazole is usually taken by mouth in doses of 200 milligrams once a day with a meal for between six months and one year. Patients with AIDS or other severe illnesses may need to take higher doses for life. Itraconazole works by blocking the development of fungal enzymes, as do other antifungal agents such as amphotericin B and ketoconazole. It is less toxic than these, although nausea and other side effects may occur at high doses. Itraconazole may interact with other medicines such as digoxin and terfenadine in ways that increase the effects or toxicity of these drugs. Itraconazole also may be effective against other fungal infections such as invasive aspergillosis and cryptococcal meningitis.

Sporanox (Medication)

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Systemic antifungal drugs

Article Abstract:

Several drugs are available for the treatment of patients with severe fungal disease. The type of fungal infection and consideration of drug interactions and patient response guide the direction of therapy. Intravenous infusion of amphotericin B deoxycholate is often the drug of choice for treatment of deep fungal infections. Side effects and kidney toxicity are sometimes reduced by new formulations recently approved by the Food and Drug Administration. Other drugs used for serious fungal infections include fluconazole, flucytosine, itraconazole and ketoconazole.

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