YEAST MEDS 'DETAILED' AND EXPLAINED

[Guest guest]

HI all, this is a file I just ran across talking about the various Yeast/fungus

meds one might take. It's in chart form so those who only get plain text may not see it correctly, *sorry*

Dee

Overview Of Prescription Drugs Used For Treating Fungus, Yeast, And Candida Infections

Fluconazole (Diflucan) (a triazole )

IV, Oral

Fungistatic against Candida, not fungicidal.Well tolerated.15%C. glabrata completely resistant to fluconazoleC. krusei is intrinsically resistant to fluconazole.Std dose = 400mg/d; if C glabrata, dose should be 800 mg/dDoses can be as high as 12 mg/kg -- for a 150 lb. person (70 kg) = 840 mg/d)For vulvovaginal candidiasis 150 mg single dose therapyOnly azole to cross blood-brain barrier to treat central nervous system infections

Voriconazole (Vfend) (a triazole )

IV, Oral

New, structurally similar to fluconazoleFungistatic against Candida, not fungicidalEnhanced activity against fluconazole-resistant C. GlabrataDose at 200 mg/twice day

Itraconazole (Sporanox) (a triazole )

IV, Oral (Capsules & Oral Solution)

Fungistatic against Candida, not fungicidalHighly lipophilic – poor penetration into aqueous fluidsCapsule form has unpredictable absorption -- Oral Solution preferredDose at 100-400 mg/d. For 400 mg/d take 200 mg/twice/day

Ketoconazole (Nizoral) (an imidazole)

Oral

Fungistatic against Candida, may be fungicidal at high dosesHighly lipophilic – poor penetration into aqueous fluids Stronger liver toxicity than for fluconazole or itraconazole.Less toxic than amphotericin-B; used for similar fungal infections.May decrease testosterone and cortisol levelsDose at 200-400 mg once/day. Can increase to 600-800 mg/day with increased risk of toxicity

Clotrimazole(Mycelex)(an imidazole)

Oral

Fungicidal against Candida.Available as a troche (lozenge) for oropharyngeal CandidiasisDosage: 10 mg five times per day

Miconazole (Monistat)(an imidazole)

Topical, oral gel

Effective against Candida - fungicidal at higher dosages.Widely used topically for skin and vaginal yeast infectionsOral gel used for oral Candidiasis in some countries.Not absorbed well orally -- not generally available in this form.No hormonal side effects.No hepatoxicity (liver)Frequent hypersensitivity - fever and chills, skin rash or itching

Flucytosine (5-F) (Ancobon)

Oral

Fungistatic, not fungicidalTransports in aqueous media. Complements lipophilic drugs.Use in combination with another drug to avoid building resistance.Resistance by Candida is possible.Dose at 25-37.5 mg/kg four times daily (100-150 mg/kg/day).

Nystatin (Mycostatin, Nilstat) (a polyene)

Oral tablets, powder, solution

Not absorbed. Useful for GI infections only. Fungicidal 4 tabs (500,000 IU's each) four times daily or equivalent oral suspension (500,000 IU's per 5 ml)

Amphotericin- B (Fungizone) (a polyene)

IV

FungicidalHigh toxicity to liver – most toxic anti-microbial in clinical useAmB is the most potent antifungal available.AmB Not absorbed by GI tract -- must use IV formulation for systemic treatment

Amphotericin- B (lipids) (a polyene)

IV

FungicidalLipid formulation of AmBCan deliver higher concentrations with lower toxicity than Amphotericin-B

Amphotericin- B(a polyene)

Oral solution, Capsule

FungicidalNo longer available in capsule & suspension forms in US except from compounding pharmaciesOral AmB absorption is negligible, not for systemic use -- for GI infections only.AmB is the most potent antifungal available.Safe: Oral formulation for GI infections avoids toxicity of IV formulation.Dosages: Oral suspension: 100 mg (1 ml) four times daily Capsule: 250 - 500 mg four times daily

Caspofungin (Cancidas)

IV

Recently approved, esp. for life-threatening fungal infections.Fungicidal for Candida spp.

Terbinafine (Lamisil)

Oral, Topical

Mainly effective on dermatophytes (skin fungi)Active against Candida in vitro.Highly lipophilic – poor penetration into aqueous fluidsHas been combined with fluconazole to treat fluconazole-resistant CandidaTypical dose 250 mg/d, systemic dose 250-500 mg once daily