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.

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.

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.

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

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.