Pharmacology: 

 
Antifungal Agents 
 
 
 

A report presented by:  

Sandot, Shylene Mae D.  
BSN 2-B 
 
 
 
 
 
What is an Antifungal? 
 Antifungals are used to treat fungal infections. Fungi are plant-like microorganisms commonly found as molds and yeasts.
The drugs chosen to treat these mycosis or mycotic infections are usually fungicidal. The fungal cell is destroyed as the
drug prevents cell permeability and nutrition.  
 
 Common fungal infections include candidiasis (vaginal yeast infection), ringworm, and athlete’s foot.  

NAME AND MECHANISM OF CONTRAINDICATIO SIDE EFFECTS ADVERSE RESPONSIBILITIES

CLASSIFICATION ACTION N REACTIONS AND PATIENT
TEACHINGS
Allylamines  It interferes *Chronic or active liver Cream or gel *Gastrointestinal *Topical Apply small
specifically with fungal disease  on skin: symptoms  amount to cover
Generic sterol biosynthesis at *History of an allergic peeling or itchy *Rash  affected area
Name: an early stage. This reaction to oral skin  *Urticaria  completely. Avoid
leads to a deficiency
Terbinafine  terbinafine  *Pruritus  the use of occlusive
in ergosterol and to an Tablet intake: 
  intracellular
*Hypersensitivity    wrappings or
Brand Name: *Lactation  *Immune Uncommon but dressings unless
accumulation of
Lamisil  squalene, resulting in *Gastrointestinal suppression mild adverse directed by
fungal cell death. issue  secondary to events:  physician or other
*Depression  hematologic *Visual health care
*Immune suppression effects (rash).  disturbances professional. 
secondary to *Headache  *Dysgeusia  *Apply medication
hematologic effects.  *Diarrhea  *Mild as directed for full
*Feeling or transaminitis  course of therapy,
being sick even if feeling
(nausea or better. 
vomiting)  * Patients with
*A smaller athlete's foot should
appetite than wear well-fitting,
usual  ventilated shoes,
*Stomachache  wash affected areas
*Indigestion
   thoroughly, and
*Muscle or joint change shoes and
pain  socks at least once
  a day. 
* Some products
INDICATION D.R.F.F.T (Dosage, PREGNANCY THERAPEUTIC may stain fabric,
Route, Frequency, CATEGORY AND EFFECTS skin, or hair, report
Form, Timing) PRECAUTION increased skin
*An allylamine Oral:  Topical: Pregnancy Decrease in irritation or lack of
antifungal is Tinea corporis, symptoms of response to therapy
category B 
used to treat Tinea cruris, Tinea fungal infection. to health care
dermatophyte  
pedis  professional.  
infections of Terbinafine is safe to
 
toenails and use in both its topical
Adult: 250mg once
fingernails as and oral forms during
well as other daily.  
pregnancy. 
fungal skin Treatment
 
infections.  duration: 2-6
Terbinafine is not
weeks (tinea
advisable during
pedis), 4
breastfeeding
weeks (tinea
because it is excreted
corporis), 2-
in breast milk. 
4 weeks
 
(tinea
cruris). 
 
Oral 
Nail fungal
infections 
 
Adult: 250 mg once
daily for 6 weeks
(fingernail) or 12
weeks (toenail). 
 
Topical/Cutaneous 

Tinea pedis 
 
Adult: As 1%
cream: Apply to
affected area 1-2
times daily for 1
week (between
toes) or 2 weeks
(bottom or sides of
feet). As spray:
Spray between the
toes for 1 week. As
gel: Apply to
affected area once
daily for 1 week. 
Child: ≥12 years as
cream or spray:
Same as adult dose.
Dosage
recommendations
may vary among
countries or
individual products.  
Topical/Cutaneous 

Cutaneous
candidiasis,
Pityriasis
versicolor 
 
Adult: As 1%
cream: Apply 1-2
times daily for 2
weeks. 
 
Topical/Cutaneous 

Tinea corporis,
Tinea cruris 
 
Adult: As 1%
cream: Apply to
affected area 1-2
times daily for 1-2
weeks. As 1% gel or
spray: Apply to
affected area once
daily for 1 week. 
Child: ≥12 years. As
1% cream or spray:
Same as adult dose.
Dosage
recommendations
may vary among
countries or
individual products. 
 NAME AND MECHANISM OF CONTRAINDICA- SIDE EFFECTS ADVERSE RESPONSIBILITIES
CLASSIFICATION ACTION TION REACTIONS AND PATIENT
TEACHINGS
Polyenes  Binds to sterols *Hypersensitivity  *Diarrhea  *Oral irritation or *Nystatin medication
  in the cell *Some nystatin oral *Nausea  sensitization can stain clothing
Generic Name:  membrane of suspension may occur  yellow, avoid using
*Stomach pain
Nystatin  susceptible fungi preparations *Large oral tampons because
  with a resultant contain sugar and or upset  doses produce they will absorb the
Brand Name:  change in are unsuitable for *Vomiting  diarrhea, drug and be careful
Mycostatin  membrane children with *Contact gastrointestinal during vaginal
permeability disaccharide dermatitis  distress, nausea preparation. 
allowing leakage intolerance.  *Stevens- and vomiting. *Continue using
of intracellular Contact nystatin lozenges for
components.  Johnson dermatitis, at least 48 hours
  syndrome  Steven after symptoms of
Exhibits no *Hypersensitivity Johnson’s infection disappear. 
activity against reactions  syndrome, *Dissolve Lozenges
bacteria, *Skin irritation or hypersensitivity in the mouth. Do not
protozoa, reactions  chew or swallow
redness 
trichomonads, or whole.  
viruses.  *Mouth *Shake the bottle
irritation  well before each use
*Rash  to mix the medication
*Hives  evenly. 
 *Allergic - For mouth
reaction  infections half the
dose should be
*Slow heart rate 
placed in each side
*Bronchospasm  of the mouth and
*Facial swelling  swished throughout
*Muscle pain  the mouth for several
  minutes before
INDICATION D.R.F.F.T PREGNANCY THERAPEUTIC swallowing. 
(D0sage, Route, CATEGORY AND EFFECTS *For intestinal
Frequency, PRECAUTION infections the
Form, Timing) suspension can
simply be
*Oropharyngeal Oral powder  US FDA pregnancy *Stops the growth swallowed. 
candidiasis  *100,000units/g  category C: Animal of fungi that cause -Ointment or cream
*Intestinal reproduction studies infection.  should be kept out of
Oral
candidiasis  have shown an the eyes. 
*Prophylaxis suspension  adverse effect on the *Gently massage a
against oral *100,000units/ fetus and there are small amount of
candidiasis  mL  no adequate and ointment or cream on
Oral tablet  well-controlled the skin thoroughly. 
studies in humans, *Refer to
*500,000units  but potential benefits manufacturer’s
Capsule  may warrant use of summary of product
*500,000units  the drug in pregnant characteristics and to
*1,000,000units   women despite appropriate local
Dosing potential risks. guidelines 
considerations:  Caution is  
  recommended. 
Oropharyngeal
candidiasis 
Premature
infants: 
100,000units,
PO, paint
suspension in
recesses of
mouth, every 6
hours 
 
Infants: 
200,000 units,
PO, paint
suspension in
recesses of
mouth, every 6
hours (100,000
units in each
side) 
 
Children:  
400,000-600,000
units, PO, swish
in mouth several
times and then
swallow, 4 times
a day. 
 
Intestinal
candidiasis: 
Oral tablets,
500,000-
1,000,000 units 3
times a day. 
 
Renal Dose: 
 Done in Renal
Impairment GFR
(mL/min) 
20-50 Dose as in
normal renal
function 
10-20 Dose as in
normal renal
function 
<10 Dose as in
normal renal
function 
 

NAME AND MECHANISM OF CONTRAINDICATION SIDE EFFECTS ADVERSE RESPONSIBILITIES

CLASSIFICATION ACTION REACTIONS AND PATIENT
TEACHINGS
Azoles  Impairs the *Patients with Less *Nausea, *Take ketoconazole
  synthesis of hypersensitivity  common— vomiting, exactly as directed.
Generic Name:  ergosterol, which is *Children under 2 For cream, abdominal pain, *Do not take more or
Ketoconazole  a vital component years of age.  shampoo, pruritus, alopecia, less of it or take it
  of fungal cell *Patients with foam, or gel  headache, more often than
Brand Name:  membranes.  acute or chronic *Itching, hyperlipidemia, prescribed by your
Nizoral  hepatic disease.  stinging, dizziness, doctor. Your doctor
burning, or diarrhea, may increase your
irritation is impotence, dose if your condition
not present thrombocytopenia does not improve. You
before use of erythema may need to take
this medicine  multiforme, ketoconazole for 6
Rare—For gynecomastia, months or longer to
cream, foam, hepatoxicity, cure your infection
or gel  xeroderma, fever completely. 
*Acne  and chills,
*Bleeding somnolence,
from sore in depression,
the mouth  bulging
*Blistering, fontanelles,
crusting, jaundice,
irritation, dysgeusia,
itching, or decreased
reddening of platelet count,
the skin  dyspepsia,
*Burning, photophobia,
crawling, hemolytic
itching, anemia,
numbness, leukopenia,
prickling, orthostatic
"pins and hypotension.  
needles", or
tingling
feelings 
*Cracked,
dry, or scaly
skin 
*Discoloration
of the
fingernails or
toenails 
*Dizziness 
*Eye dryness,
irritation, or
swelling 
*Red rash
with watery,
yellow-
colored, or
pus-filled
blisters with
or without
thick yellow
to honey-
colored
crusts 
*Skin
dryness,
pain, rash,
redness, or
swelling 
*Sore in the
mouth or on
the gums 
*Swelling of
the face 
Rare—For
shampoo 
*Hair loss
and irritation 
For gel 
 Pain 
Incidence not
known—For
shampoo 
*Blistering,
burning,
crusting,
dryness, or
flaking of the
skin 
*Burning
sensation of
the skin 
*Burning,
itching,
redness, skin
rash,
swelling, or
soreness at
the
application
site 
*Discoloration
of the hair 
*Dry skin 
*Fast
heartbeat 
*Fever 
*Hives 
*Hoarseness 
*Irritation 
*Itching,
scaling,
severe
redness, or
soreness of
the skin 
*Joint pain,
 stiffness, or
swelling 
*Rash 
*Shortness of
breath 
*Swelling of
the eyelids,
face, lips,
hands, or
feet 
*Thinning of
the hair 
*Tightness in
the chest 
*Troubled
breathing or
swallowing 
*Wheezing

INDICATION D.R.F.F.T PREGNANCY THERAPEUTIC

(D0sage, Route, CATEGORY AND EFFECTS
Frequency, PRECAUTION
Form, Timing)
*Patients of systemic Renal Dose:  US FDA pregnancy Kills the fungus or
fungal infections who Dose in Renal category C There are no yeast or prevents
have failed other Impairment GFR known risks associated its growth.
therapy or are (mL/min)  with use of this drug
intolerant.    during pregnancy; no
*Histoplasmosis  *20-50 Dose as effects on the neonate
*Blastomycosis  in normal renal expected. 
*Para function 
coccidioidomycosis  10-20 Dose as in
*Coccidioidomycosis  normal renal
*Chromomycosis  function 
*<10 Dose as in
normal renal
function 
 
Hepatic Dose: 
Oral use is
contraindicated in
patients with
acute or chronic
hepatic disease.
Monitor liver
function weekly
for one month
after initiation of
the treatment,
then monthly for
6 months and
then weekly for
one month
whenever the
dose increased.  
*ALT or AST >3
times the ULN.
Discontinue the
drug and do not
restart. 
*ALT or AST <3
times the ULN:
more frequent
monitoring of liver
function test and
 the daily dose
should be
decreased. 
NOTE: Use of
shampoo or
cream in patients
with liver disease
is not
contraindicated.   

NAME AND MECHANISM CONTRAINDIC SIDE ADVERSE RESPONSIBILITIES AND PATIENT

CLASSIFICATION OF ACTION ATION EFFECTS REACTIONS TEACHINGS
Antimetabolite  Acts directly *Patient with *Agitation  Confusion  WARNING: This medication should be used
  on fungal hypersensitivity  *Black, bloody, Headache  with increased caution if you have kidney
Generic Name:   organisms by *Pregnant tarry stools  Hallucination problems. Flucytosine may cause decreased
Flucytosine  competitive women  *Blistering, s  kidney function and liver problems. In addition,
  inhibition of (Flucytosine use peeling, or Dizziness  this medication may decrease bone marrow
Brand Name:  purine and is not indicated loosening of Drowsiness  function. This serious, possibly life-threatening
Ancobon  pyrimidine during the first the skin  Psychosis  side effect may lead to a low number of blood
uptake and trimester as *Bloody or Parkinsonis cells such as red cells, white cells, and
indirectly by anatomic cloudy urine  m  platelets. This effect can cause anemia,
intracellular irregularities *Burning, Ataxia  decrease your body's ability to fight an infection,
metabolism to have appeared crawling, Sedation  and cause bleeding problems. Your doctor will
5-fluorouracil. during aborted itching, Rash  check the results of your kidney, liver, and
pregnancies).  numbness, Photosensitiv blood tests and adjust your treatment to reduce
prickling, "pins ity  your risk for these side effects. See also the
and needles", Pruritus  Side Effects section. 
or tingling Urticaria  USES: Flucytosine is used to treat serious
feelings  Temporary fungal infections in the body. It belongs to a
*Burning upper growth class of drugs known as antifungal drugs. It is
abdominal or failure  often used with other medications. It works by
stomach pain  Hypoglycemi slowing the growth of certain types of fungus. 
*Change in a  HOW TO USE: Take this medication by mouth
consciousness  Hypokalemia  as directed by your doctor, usually 4 times a
*Chest pain or Nausea  day (every 6 hours). To reduce stomach upset,
tightness  Vomiting  do not swallow all the capsules for one dose at
*Chills  Diarrhea  the same time. It may be best to swallow the
*Confusion  Abdominal capsules for each dose over a 15-minute period
*Cough or pain  until the full dose is taken. The dosage is based
hoarseness  Loss of on your medical condition, weight, and
*Dark urine  appetite  response to treatment. This medication works
*Decreased Bone marrow best when the amount of drug in your body is
urine output  suppression  kept at a constant level. Take this drug at
*Depression  Anemia  evenly spaced intervals. To help you remember,
*Diarrhea  Leukopenia  take it at the same time each day. Continue to
*Dizziness  Thrombocyto take this medication until the full prescribed
*Dry mouth  penia  amount is finished, even if symptoms disappear
*Feeling of Elevated after a few days. Stopping the medication too
constant liver early may allow the fungus to continue to grow,
movement of enzymes  which may result in a return of the infection. Tell
self or Hepatitis  your doctor right away if your condition lasts or
surroundings  Azotemia  gets worse. 
*Fever  Peripheral PRECAUTIONS: Before taking flucytosine, tell
*Headache  neuropathy  your doctor or pharmacist if you are allergic to it
*Hearing loss  Paresthesia  or if you have any other allergies. This product
*Hives, itching, Weakness H may contain inactive ingredients, which can
skin rash  earing loss  cause allergic reactions or other problems. Talk
*Increased Elevated to your pharmacist for more details. Before
sensitivity of BUN and using this medication, tell your doctor or
the skin to serum pharmacist your medical history, especially of:
sunlight  creatinine  kidney problems, liver problems, decreased
*Irregular Renal failure  bone marrow function (low white, red or platelet
heartbeat  Respiratory blood counts), a certain metabolic disorder
*Irritability  arrest  (DPD enzyme deficiency), radiation treatment,
*Joint or Anaphylaxis  mineral imbalance (such as low level of
muscle pain    potassium in the blood).Flucytosine can make
*light-colored you more likely to get infections or may worsen
stools  any current infections. Avoid contact with
*Loss of people who have infections that may spread to
appetite  others (such as chickenpox, measles, flu).
*Loss of Consult your doctor if you have been exposed
consciousness  to an infection or for more details. Tell your
*Lower back or health care professional that you are using
side pain  flucytosine before having any
*Mood immunizations/vaccinations. Avoid contact with
changes  people who have recently received live
*Muscle vaccines (such as flu vaccine inhaled through
cramps or the nose). To lower the chance of getting cut,
twitching  bruised, or injured, use caution with sharp
*Nausea  objects like razors and nail cutters, and avoid
*No blood activities such as contact sports. During
pressure or pregnancy, this medication should be used only
pulse  when clearly needed. This medication is not
*No breathing  recommended for use during the first 3 months
*Numbness or of pregnancy. It may harm an unborn baby.
tingling in the Discuss the risks and benefits with your doctor.
hands, feet, or It is unknown if this drug passes into breast
lips  milk. Because of the possible risk to the infant,
*Painful or breast-feeding while using this drug is not
difficult recommended. Consult your doctor before
urination  breast-feeding. 
*Pain in the
lower back or
side pale skin 
*Rapid weight
gain 
*Rectal
bleeding 
*Red irritated
eyes 
*Red skin
lesions, often
with a purple
center 
*Redness of
the skin 
*Seeing,
hearing, or
feeling things
that are not
there 
*Seizures 
*Sensation of
spinning 
*Severe
sunburn 
*Shakiness and
unsteady walk 
*Sore throat 
*Sores, ulcers,
or white spots
on the lips or in
the mouth 
*Stopping of
the heart 
*Swelling of the
face, ankles, or
hands 
*Swollen
glands 
*Thirst 
*Trouble
breathing 
*Unpleasant
breath odor 
*Unsteadiness,
trembling, or
other problems
with muscle
control or
coordination 
*Unusual
bleeding or
bruising 
*Unusual
drowsiness,
dullness,
tiredness,
weakness or
feeling of
sluggishness 
*Vomiting 
*Vomiting of
blood or
material that
looks like
coffee grounds 
*Weakness in
the arms,
hands, legs, or
feet 
 *Weight loss 
*Yellow eyes or
skin 
 

INDICATION D.R.F.F.T PREGNANCY THERAPEUTI

(D0sage, CATEGORY C EFFECTS
Route, AND
Frequency, PRECAUTION
Form,
Timing)
Treatment (in Usual Adult Category C Slows down the
combination with Dose for growth of certain
amphotericin B) of Candida Should only be types of fungus. 
serious infections Urinary used during
caused by Tract pregnancy only
susceptible strains Infection  if the benefit
of Candida 50 to 150 outweighs the
(septicemia, mg/kg/day risk.
endocarditis and orally in
urinary system divided doses
infections) and/or every 6
Cryptococcus hours 
(meningitis and Usual Adult
pulmonary Dose for
infections). Candidemia 
50 to 150
mg/kg/day
orally in
divided doses
every 6
hours 
Usual Adult
Dose for
Cryptococca
l Meningitis -
Immunocom
petent Host 
50 to 150
mg/kg/day
orally in
divided doses
every 6
hours 
Usual Adult
Dose for
Cryptococca
l Meningitis -
Immunosup
pressed
Host 
50 to 150
mg/kg/day
orally in
divided doses
every 6
hours 
Usual Adult
Dose for
Cryptococco
sis 
50 to 150
mg/kg/day
orally in
divided doses
every 6
hours 
Usual Adult
Dose for
Fungal
Endocarditis 
50 to 150
mg/kg/day
orally in
divided doses
every 6
hours 
Usual Adult
Dose for
Systemic
Fungal
Infection 
50 to 150
mg/kg/day
orally in
divided doses
every 6
hours 
Usual
Pediatric
Dose for
Systemic
Fungal
Infection 
American
Academy of
Pediatrics
Recommend
ations: 100
mg/kg/day
orally in
divided doses
every 6
hours