Medications for Systemic Fungal Infections
Medication | Uses | Potential Adverse Effects |
|---|---|---|
Amphotericin B | Most fungal infections | Conventional formulation: Acute infusion reactions, neuropathy, gastrointestinal (GI) upset, renal failure, anemia, thrombophlebitis, hearing loss, rash, hypokalemia, hypomagnesemia |
Lipid formulations: Infusion reactions*, renal failure* | ||
Anidulafungin | Invasive candidiasis, including candidemia | Hepatitis, diarrhea, hypokalemia, infusion reactions |
Caspofungin | Invasive candidiasis, including candidemia | Phlebitis, headache, GI upset, rash |
Fluconazole | Mucosal and systemic candidiasis Coccidioidal meningitis | GI upset, rash, hepatitis, QT prolongation |
Flucytosine† | Candidiasis (systemic) | Pancytopenia due to bone marrow toxicity, neuropathy, nausea, vomiting, hepatic and renal injury, colitis |
Isavuconazonium sulfate (isavuconazole)‡ | Nausea, vomiting, hepatitis, QT shortening with no evidence of cardiac risk, infusion-related reactions | |
Itraconazole | Dermatomycosis Histoplasmosis, blastomycosis, coccidioidomycosis, paracoccidioidomycosis, sporotrichosis, aspergillosis, chromoblastomycosis | Hepatitis, GI upset, rash, headache, dizziness, hallucinations, hypokalemia, hypertension, edema, QT prolongation, heart failure |
Micafungin | Invasive candidiasis, including candidemia | Phlebitis, hepatitis, rash, headache, nausea, acute intravascular hemolysis |
Osteoconazole | Vulvovaginal candidiasis | Headache, nausea, indigestion, hot flushes, painful urination, heavy menstrual periods, vaginal irritation |
Posaconazole§ | Prophylaxis for invasive fungal infection Histoplasmosis | Hepatitis, GI upset, rash, QT prolongation |
Rezafungin | Invasive candidiasis, including candidemia | Photosensitivity, abnormal liver tests, infusion-related reactions (flushing, sensation of warmth, urticaria, nausea, chest tightness) |
Voriconazole | Candidiasis, including candidemia Fusariosis Scedosporiosis | GI upset, transient visual disturbances, peripheral edema, rash, hepatotoxicity, hallucinations, QT prolongation |
* These adverse effects are less common with lipid formulations than with the conventional formulation. | ||
† Amphotericin B is used with flucytosine for serious Candida and cryptococcal infections. | ||
‡ Isavuconazole is given as the prodrug isavuconazonium sulfate; 372 mg of isavuconazonium sulfate is equivalent to 200 mg of isavuconazole. | ||
§ The delayed-release tablets, delayed-release oral suspension, and immediate-release oral suspension of posaconazole are NOT interchangeable because of differences in dosing. | ||