Antifungal Drugs, Systemic Health Article

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take systemic antifungal drugs. Before taking these drugs, the prescribing physician should be informed about any of the following conditions:

ALLERGIES. Anyone who has had unusual reactions to systemic antifungal drugs in the past should let his or her physician know about the problem before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. In laboratory studies of animals, systemic antifungal drugs have caused birth defects and other problems in the mother and fetus. Studies have not been done on pregnant women, so it is not known whether these drugs cause similar effects in people.

Women who are pregnant or who plan to become pregnant should check with their physicians before taking systemic antifungal drugs. Any woman who becomes pregnant while taking these drugs should let her physician know immediately.

BREASTFEEDING. Systemic antifungal drugs pass into breast milk. Women who are breastfeeding should check with their physicians before using systemic anti-fungal drugs.

OTHER MEDICAL CONDITIONS. People who have medical conditions that deplete stomach acid (achlorhydria) or decrease stomach acid (hypochlorhydria) should be sure to inform their physicians about their condition before they use a systemic antifungal drug. These drugs are not active in their natural form, but must be converted to the active form by an acid. If these is not enough stomach acid, the drugs will be ineffective. For people with insufficient stomach acid, it may help to take the medicine with an acidic drink, such as a cola. The patient's health care provider can suggest the best way to take the medicine.

Before using systemic antifungal drugs, people with any of these medical problems should also make sure their physicians are aware of their conditions:

• current or past alcohol abuse
• liver disease
• kidney disease

USE OF CERTAIN MEDICINES. Taking systemic anti-fungal drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Fluconazole

Although rare, severe allergic reactions to this medicine have been reported. Call a physician immediately if any of these symptoms develop after taking fluconazole (Diflucan):

• hives, itching, or swelling
• breathing or swallowing problems
• sudden drop in blood pressure
• diarrhea
• abdominal pain

Ketoconazole

Ketoconazole has caused anaphylaxis (a life-threatening allergic reaction) in some people after their first dose. This is a rare reaction.

Systemic antifungal drugs in general

Systemic antifungal drugs may cause serious and possibly life-threatening liver damage. Patients who take these drugs should have liver function tests before they start taking the medicine and as often as their physician recommends while they are taking it. The physician should be notified immediately if any of these symptoms develop:

• loss of appetite
• nausea or vomiting
• yellow skin or eyes
• unusual fatigue
• dark urine
• pale stools

The most common minor side effects of systemic antifungal drugs are constipation, diarrhea, nausea, vomiting, headache, drowsiness, dizziness, and flushing of the face or skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects, such as menstrual problems in women, breast enlargement in men, and decreased sexual ability in men also may occur and do not need medical attention unless they do not improve in a reasonable amount of time.

More serious side effects are not common, but may occur. If any of the following side effects occur, check with the physician who prescribed the medicine immediately:

• fever and chills
• skin rash or itching
• high blood pressure
• pain, redness, or swelling at site of injection (for injectable miconazole)

Other rare side effects are possible. Anyone who has unusual symptoms after taking systemic antifungal drugs should get in touch with his or her physician.