2. Antifungal AgentsP

Drug

Preparation

Side Effects

amphotericin BO Soln:

burning, irritation

Subconj:

local ischemic necrosis, subconjunctival nodule

Intravitreal:

chemosis, corneal clouding, possible risk of retinal toxicity

Intravenous: we recommend giving in consultation with infectious disease specialist or physician familiar with its use

(consider a test dose to monitor for severe reaction). Rapid infusion canresult in hypotension,

hypokalemia, arrhythmias, and shock. Fever, chills, hypotension, anddyspnea are common.

Nephrotoxicity, renal tubular acidosis, electrolyte abnormalities (hypokalemia and hypomagnesemia),

fluconazoleOb

anemia, headache, nausea, vomiting, malaise, weightloss, phlebitis, thrombocytopenia, mild leukopenia.

PO:

GI distress, allergic rash, eosinophillia, Stevens-Johnson syndrome, transaminase elevation,

flucytosineO

thrombocytopenia. Increases concentrations of phenytoin, sulfonylureas, warfarin, and cyclosporine.

Soln:

burning, irritation (typically less than amphotericin)

PO:

marrow suppression leading to leukopenia and thrombocytopenia, rash, nausea, vomiting, severe

itraconazoleb

enterocolitis, hepatotoxicity, renal toxicity, and cardiac arrest.

PO:

nausea, vomiting, rash, pruritus, weakness, dizziness, vertigo, pedal edema, paresthesias, impotence,

ketoconazoleOb

loss of libido.

PO:

nausea, anorexia, vomiting, allergic rash, pruritus, gynecomastia, decreased libido/impotence,

hypertension, and fluid retention secondary to concentrations of adrenalcortical steroids, elevated LFTs

miconazole

Soln:

burning, itching, irritation

Subconj:

generally well tolerated

natamycin

Soln:

less irritating than amphotericin

voriconazole

PO:

visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache transaminase elevation, need to

monitor liver function tests

Soln:

burning, irritation