Examples: Nystatin, Terbinafine, Ketoconazole, Fluconazole, Itraconazole, Posaconazole, Voriconazole
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Indications:
oral candidiasis, vaginal candidiasis, skin infections, nail infection, opporutnistic infection
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Dosing:
Nystatin Liquid: Swish and (either spit or swallow) QID after meals (for topical mucous membanes such as mouth and esophageal)
**Other medications can be dosed once daily (sometimes twice daily if a high dose is prescribed)
**Most can be dosed with food (especially ketoconazole, posaconazole and itraconazole tablets which require acidity), except for itraconazole liquid and voriconazole (empty stomach)
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Adverse Effects:
-Elevated liver enzymes
-nausea, headache, rash
-QT prolongation
-heart failure (itraconazole)
-gynecomastia, loss of libido (ketoconazole)
-photosensitivity, visual disturbances (voriconazole)
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Drug Interactions:
*avoid alcohol with all medications due to hepatotoxicity
-Terbinafine is a CYP2D6 inhibitor - be careful with substrates such as tamoxifen, duloxetine, aripiprazole and tricyclic antidepressants
-Fluconazole and voriconazole are CYP2C9, 2C19 and 3A4 inhibitors - careful with many substrates including warfarin, fluoxetine
-Itraconazole, posaconazole and ketoconazole are 3A4 inhibitors
-acid-reducing medications may reduce the absorption of itraconazole and ketoconazole tablets (ex. proton pump inhibitors, antacids, H2 receptor antagonists)