What are antifungal medicines?
Antifungal medicines are used to treat fungal infections, which most commonly affect your skin, hair and nails.
You can get some antifungal medicines over the counter from your pharmacy, but you may need a prescription from your doctor for other types.
This page covers:
Infections antifungals can treat
Types of antifungal medicine
How they work
When to see a pharmacist or doctor
Things to consider
Side effects
Use in children
Infections antifungals can treat
Fungal infections commonly treated with antifungals include:
- ringworm
- athlete's foot
- fungal nail infection
- vaginal thrush
- some kinds of severe dandruff
Less commonly, there are also more serious fungal infections that develop deep inside the body tissues, which may need to be treated in hospital.
Examples include:
- aspergillosis , which affects the lungs
- fungal meningitis , which affects the brain
You're more at risk of getting one of these more serious fungal infections if you have a weakened immune system – for example, if you're taking medicines to suppress your immunity.
Types of antifungal medicines
Antifungal medicines are available as:
- topical antifungals – a cream, gel, ointment or spray you can apply directly to your skin, hair or nails
- oral antifungals – a capsule, tablet or liquid medicine that you swallow
- intravenous antifungals – an injection into a vein in your arm, usually given in hospital
- intravaginal antifungal pessaries – small, soft tablets you can insert into the vagina
Some common names for antifungal medicines include:
- clotrimazole
- econazole
- miconazole
- terbinafine
- fluconazole
- ketoconazole
- amphotericin
How antifungal medicines work
Antifungal medicines work by either:
- killing the fungal cells – for example, by affecting a substance in the cell walls, causing the contents of the fungal cells to leak out and the cells to die
- preventing the fungal cells growing and reproducing
When to see a pharmacist or doctor
See a pharmacist or doctor if you think you have a fungal infection. They will advise you on which antifungal medicine to take and how to take or use it. See below for some questions you may want to ask them.
The patient information leaflet that comes with your medicine will also contain advice on using your medicine.
Speak to your pharmacist or doctor if you accidentally take too much of your antifungal medicine. You may be advised to visit your nearest hospital's emergency department if you've taken excessive amounts.
If you're advised to go to hospital, take the medicine's packaging with you so the healthcare professionals who treat you know what you've taken.
Things to consider when using antifungal drugs
Before taking antifungal medicines, speak to a pharmacist or your doctor about:
- any existing conditions or allergies that may affect your treatment for fungal infection
- the possible side effects of antifungal medicines
- whether the antifungal medicine may interact with other medicines you may already be taking (known as drug interactions)
- whether your antifungal medicine is suitable to take during pregnancy or while breastfeeding – many aren't suitable
You can also check the patient information leaflet that comes with your antifungal medicine for more information.
Side effects of antifungal medicines
Your antifungal medicine may cause side effects. These are usually mild and only last for a short period of time.
They can include:
- itching or burning
- redness
- feeling sick
- tummy (abdominal) pain
- diarrhoea
- a rash
Occasionally, your antifungal medicine may cause a more severe reaction, such as:
- an allergic reaction – your face, neck or tongue may swell and you may have difficulty breathing
- a severe skin reaction – such as peeling or blistering skin
- liver damage (occurs very rarely) – you may experience loss of appetite, vomiting, nausea, jaundice , dark urine or pale faeces, tiredness or weakness
Stop using the medicine if you have these severe side effects, and see your doctor or pharmacist to find an alternative.
If you're having difficulty breathing, visit the emergency department of your nearest hospital or call for an ambulance.
Reporting side effects
If you suspect that a medicine has made you unwell, you can report this side effect through the Yellow Card Scheme.
The scheme is run by a medicines safety watchdog called the Medicines and Healthcare Products Regulatory Agency (MHRA).
Antifungal medicines for children
Some antifungal medicines can be used on children and babies – for example, miconazole oral gel can be used to treat oral thrush in babies .
But different doses are usually needed for children of different ages. Ask a pharmacist or speak to your doctor for more advice.
What are antifungal medicines used for?
Antifungal medicines have many brand names as they are made by different pharmaceutical manufacturers.
There are also many different types of antifungal medicines, including:
- clotrimazole
- econazole nitrate
- miconazole
- terbinafine
- fluconazole
- ketoconazole
- amphotericin
The packaging should state what antifungal medicine the product contains and how much. This may be shown as a percentage – for example, cream containing 1% clotrimazole, or in milligrams (mg) – for example, capsules containing 50mg of fluconazole.
Types of antifungal medicines
Antifungal medicines are available as:
- topical antifungals – a cream, gel, ointment or spray applied directly to the body
- oral antifungals – a capsule, tablet or liquid medicine that is swallowed
- intravenous antifungals – an injection into a vein in your arm, usually in hospital through an intravenous infusion (a continuous drip of medicine through a narrow tube)
Antifungal intravaginal pessaries are also available. Pessaries are small suppositories inserted into the vagina to treat conditions such as vaginal thrush.
Side-effects of antifungal medicines
Antifungal medicines can cause side effects. These will differ depending on the type of antifungal medicine you are using.
Topical antifungals
Topical antifungal medicines, such as creams, can cause:
- itching
- a mild burning sensation
- redness
Stop using the medicine if any of these side effects are severe and see your doctor or pharmacist to find an alternative.
Oral antifungals
Side effects of oral antifungals, such as capsules, include:
- feeling sick
- abdominal (tummy) pain
- diarrhoea
- flatulence (wind)
- headache
- a rash
- indigestion
These side effects are usually mild and only last for a short period of time.
Antifungals can also cause severe reactions, such as:
- an allergic reaction – swelling of your face, neck or tongue or difficulty breathing
- a severe skin reaction – such as peeling or blistering skin
If you experience any of these reactions, stop taking your medicine and contact your doctor immediately.
If you are having difficulty breathing, visit the accident and emergency (A&E) department of your nearest hospital or call for an ambulance.
Liver damage
Liver damage is a rare, but more serious, side effect of oral antifungals. In particular, ketoconazole has been linked to liver problems.
If you experience any of the symptoms listed below, stop taking your medicine and contact your doctor because they may be caused by damage to your liver:
- loss of appetite
- vomiting
- feeling sick for a long time
- jaundice – yellowing of your skin or the whites of your eyes
- unusually dark urine or pale faeces (stools)
- unusual tiredness or weakness
Intravenous antifungals
Amphotericin (amphotericin B) is the most commonly used intravenous antifungal. This is usually given in hospital as an intravenous infusion (a continuous drip of medicine into a vein in your arm).
Side effects of amphotericin include:
- loss of appetite
- feeling sick
- vomiting
- diarrhoea
- epigastric pain (pain in the upper part of your tummy)
- a high temperature (fever)
- chills
- headache
- muscle and joint pain
- anaemia (a reduced number of red blood cells)
- a rash
Amphotericin can also affect your:
- kidneys – causing abnormally low levels of some minerals in your blood, such as potassium or magnesium
- heart – causing an irregular heartbeat or changes in your blood pressure
- liver – affecting the way your liver functions, for example, causing a build-up of bilirubin in the blood; bilirubin is a yellow substance that is produced when red blood cells are broken down
- nervous system – affecting your brain, nerves and spinal cord, causing conditions such as hearing loss or peripheral neuropathy
As amphotericin is given in hospital under supervision, any adverse effects are usually quickly detected and treated.
Interactions with antifungal medicines
When two or more medicines are taken at the same time, the effects of one of the medicines can be altered by the other. This is known as a drug-drug interaction. Some antifungal medicines can interact with other medicines.
Tell your doctor or pharmacist what other medicines you are taking, including over-the-counter medicines, so they can decide whether an antifungal medicine is safe for you to take.
Medicines that antifungal medicines may interact with include:
- benzodiazepines – a group of medicines used to help sleep and reduce anxiety
- ciclosporin – a medicine that suppresses the immune system (the body’s natural defence against illness and infection)
- cimetidine – a medicine used to treat indigestion
- hydrochlorothiazide – a medicine used to treat high blood pressure (hypertension)
- oestrogens – hormones found in some contraceptives
- phenytoin – a medicine used to treat epilepsy
- progestogens - hormones found in some contraceptives
- rifampicin – an antibiotic used to treat bacterial infections, such as tuberculosis
- tacrolimus – a medicine that suppresses the immune system
- theophylline – a medicine used to treat asthma
- tricyclic antidepressants – medicines used to treat depression
- zidovudine – a medicine used to treat HIV and AIDS
Considerations of antifungal medicines
Before you take antifungals there are a number of things you should discuss with your doctor.
Allergies
You are generally advised not to take an antifungal medicine if you are allergic to the medicine or any of the ingredients used in it.
In some cases, such as when treating invasive fungal infections in hospital, your doctors may feel the benefit of the medicine outweighs the risk of an allergic reaction. They may decide to use the medicine and monitor you closely.
Other conditions
Be careful with some oral antifungals if you have problems with your heart, liver or kidneys.
Discuss your condition with your doctor or pharmacist to find out which antifungal medicines are safe for you to use.
Topical antifungals
If you are using a topical antifungal medicine, such as a cream, avoid it coming into contact with:
- your eyes
- moist linings (mucous membranes), for example, inside your nose or mouth (unless it is a gel that is supposed to be used in your mouth)
Contraceptives
Some antifungal medicines are designed to be used on a man's penis or in or around a woman's vagina. Antifungal creams or vaginal suppositories (pessaries) are sometimes used to treat thrush.
However, these types of antifungal medicines can damage latex condoms and diaphragms, making them less effective. Use a different method of contraception while you are using the antifungal medicine, or avoid having sex.
Some types of antifungal medicines can also interact with oestrogens and progestogens, which are found in some types of hormonal contraceptives, such as the combined contraceptive pill. You may experience some breakthrough bleeding while taking your antifungal medicine, but your contraceptive protection should not be affected.
Only oral antifungal medicines interact with oestrogens.
Pregnancy
Many antifungal medicines are not suitable to take during pregnancy. Check the patient information leaflet that comes with your medicine to find out.
However, if you have vaginal thrush during pregnancy, your doctor may prescribe an antifungal suppository that can be inserted into your vagina (a pessary) or an antifungal cream.
Breastfeeding
Small amounts of some medicines can pass into your breast milk and may then be passed on to your baby if you are breastfeeding. Check the patient information leaflet that comes with your antifungal medicine, as many medicines should not be taken while breastfeeding.
