Amphotericin B has been used successfully during pregnancy, but it should be used cautiously. It crosses into breast milk and should not be used during lactation because of the potential risk to the neonate. Because flucytosine is excreted primarily in the urine, extreme caution is needed in the presence of renal impairment because drug accumulation and toxicity can occur. Toxicity is associated with serum levels higher than 100 mcg/mL. Because of the potential for adverse reactions in the fetus or neonate, flucytosine should be used during pregnancy and lactation only if the benefits clearly outweigh the risks. It is not known whether nystatin crosses the placenta or enters breast milk, so it should not be used during pregnancy or lactation unless the benefits clearly outweigh the potential risks.
Patients should be monitored closely for any changes in liver or kidney functions. Bone marrow suppression has also been reported with the use of these drugs. Rash and dermatological changes have been reported with these antifungals. Amphotericin B is associated with severe renal impairment, bone marrow suppression, GI irritation with nausea, vomiting, and potentially severe diarrhea, anorexia and weight loss, and pain at the injection site with the possibility of phlebitis or thrombophlebitis. The adverse effects of griseofulvin are relatively mild, with headache and central nervous system (CNS) changes occurring most frequently Patients who receive amphotericin B should not take other nephrotoxic drugs such as nephrotoxic antibiotics or antineoplastics, cyclosporine, or corticosteroids unless absolutely necessary because of the increased risk of severe renal toxicity. Some antifungal drugs are available only in topical forms for treating a variety of mycoses of the skin and mucous membranes. o Fungi that cause these mycoses are called dermatophytes. o These mycoses include tinea infections such as athlete’s foot (tinea pedis), jock itch (tinea cruris), and yeast infections of the mouth and vagina often caused by Candida. o Topical antifungals are agents that are too toxic to be used systemically but are effective in the treatment of local fungal infections. o Topical antifungals include the azole-type antifungals—butoconazole (Gynazole), clotrimazole (Lotrimin, Mycelex), econazole (Spectazole), eficonazole (Jublia), ketoconazole (Extina, Nizoral, Xolegel), miconazole (Fungoid, Lotrimin AF, Monistat), oxiconazole (Oxistat), sertaconazole nitrate (Ertaczo), sulconazole (Exelderm), terbinafine (Lamisil), terconazole (Terazol), and tioconazole (Vagistat-1, Monistat-1)—and other antifungals—butenafine (Mentax), ciclopirox (Loprox, Penlac Nail Lacquer), gentian violet (generic), naftifine (Naftin), tolnaftate (Aftate, Tinactin), and undecylenic acid (Cruex, Desenex, Pedi-Dri, Fungoid AF) The topical antifungal drugs work to alter the cell permeability of the fungus, causing prevention of replication and fungal death These drugs are not absorbed systemically and do not undergo metabolism or excretion in the body.
- Spring '14
- Pharmacology, Blood sugar, Clinical trial, U.S. Food and Drug Administration