ANTIFUNGAL MEDICATIONS








Terbinafine (Lamisil®)

Dosage forms

Tablet
  • 250 mg ($)
Cream, OTC
  • 1% cream ($)
Spray, OTC
  • 1% spray ($)

Dosing

Pediatric (≥ 2 years)
  • Tinea capitis
    • Terbinafine tablets
      • NOTE: Tablet dosing based on one study [PMID 12195561]
      • Weight 10 - 20 kg: 62.5 mg daily for 4 weeks
      • Weight 20 - 40 kg: 125 mg daily for 4 weeks
      • Weight > 40 kg: 250 mg daily for 4 weeks
    • Terbinafine granules
      • NOTE: Terbinafine granules are FDA-approved for children ≥ 4 years old
      • Weight < 25 kg: 125 mg daily for 6 weeks
      • Weight 25 - 35 kg: 187.5 mg daily for 6 weeks
      • Weight > 35 kg: 250 mg daily for 6 weeks (PI)
  • Tinea corporis / pedis / cruris / manuum
    • Terbinafine tablets
      • NOTE: Tablet dosing based on study in children ≥ 2 years old with tinea capitis [PubMed 12195561]
      • Weight 10 - 20 kg: 62.5 mg daily for 2 - 4 weeks
      • Weight 20 - 40 kg: 125 mg daily for 2 - 4 weeks
      • Weight > 40 kg: 250 mg daily for 2 - 4 weeks ($)
  • Tinea versicolor - topical terbinafine applied twice daily for one week (CTE) NOTE: Oral terbinafine is not effective for tinea versicolor
Adults

Other

  • May take without regard to food
  • Terbinafine granules are FDA-approved in children ≥ 4 years. Terbinafine tablets have been used in children as young as 2 years - (See PubMed 12195561)
  • Terbinafine is a moderate CYP2D6 inhibitor
  • May cause taste and smell disturbances
  • Manufacturer recommends pretreatment transaminases (AST, ALT). If normal, start therapy and recheck if the patient develops clinical signs of liver disease (e.g. persistent nausea, jaundice, dark urine, abdominal pain).
  • Kidney disease
    • CrCl ≤ 50 ml/min: clearance decreased by 50%. Manufacturer makes no specific dosage recommendations.

Fluconazole (Diflucan®)

Dosage forms

Tablet
  • 50 mg ($)
  • 100 mg ($)
  • 150 mg ($)
  • 200 mg ($)
Suspension
  • 50 mg/5 ml ($)
  • 200 mg/5 ml ($)

Dosing

Pediatric
Adults

Other

Studies

Pregnancy risk

Itraconazole (Sporanox®)

Dosage forms

Capsule
  • 100 mg ($)
Capsule (Tolsura®)
  • 65 mg ($$$$)
Tablet (Onmel®)
  • 200 mg ($$$$)
Solution
  • 10 mg/ml ($$-$$$)

Dosing

Pediatric (infants)
Pediatric (≥ 1 year)
  • Tinea capitis
    • 5 mg/kg once daily for 2 - 4 weeks
    • Alternative:
      • Weight < 20 kg: 50 mg once daily for 4 weeks
      • Weight > 20 kg: 100 mg once daily for 4 weeks
      • Based on PMID 11069511
Adults
Adults (Tolsura®)
  • NOTE: Tolsura is not interchangeable or substitutable with other itraconazole products due to differences in dosing
  • Blastomycosis and Histoplasmosis - 130 mg once daily. If no obvious improvement, or there is evidence of progressive fungal disease, the dose should be increased in 65 mg increments to a maximum of 130 mg twice daily. Doses above 130 mg/day should be given in two divided doses.
  • Aspergillosis - 130 mg once daily. Increase to 130 mg twice daily if necessary.
  • NOTE: Tolsura is not indicated for the treatment of onychomycosis

Other


Oteseconazole (Vivjoa®)

Dosage forms

Capsule
  • 150 mg ($$$$)
  • Comes in carton with 18 capsules

Dosing

Recurrent vulvovaginal candidiasis in females who are NOT of reproductive potential
  • Vivjoa-only regimen
    • On Day 1: 600 mg as a single dose
    • On Day 2: 450 mg as a single dose
    • Beginning on Day 14: 150 mg once weekly for 11 weeks
    • Take with food. Do not chew, crush, dissolve, or open the capsules.
  • Fluconazole/Vivjoa regimen
    • On Day 1, Day 4, and Day 7: fluconazole 150 mg
    • On Days 14 through 20: Vivjoa 150 mg once daily for 7 days
    • Beginning on Day 28: Vivjoa 150 mg once weekly for 11 weeks
    • Take with food. Do not chew, crush, dissolve, or open the capsules.

Other

  • Females of reproductive potential - DO NOT GIVE. May cause fetal harm.
  • Pregnant and lactating women - DO NOT GIVE. May cause fetal harm.
  • BCRP substrates - oteseconazole is a BCRP inhibitor and may increase exposure to BCRP substrates (e.g. rosuvastatin). Consider reducing the dose of the concomitant substrate when combining.
  • Kidney disease
    • CrCl ≥ 30 ml/min: no dose adjustment necessary
    • CrCl < 30 ml/min: has not been studied. Not recommended.
  • Liver disease
    • Child-Pugh A: no dose adjustment necessary
    • Child-Pugh B/C: has not been studied. Not recommended.

Studies


Posaconazole (Noxafil®)

Dosage forms

Tablet, delayed-release
  • 100 mg ($$$$)
Oral suspension
  • 40 mg/ml ($$$$)
  • Comes in 105 ml bottle

Dosing

Adults and children ≥ 13 years
  • Prophylaxis of invasive Aspergillus and Candida infections
    • Tablets, delayed-release
      • Loading dose: 300 mg twice a day on the first day
      • Maintenance: 300 mg once daily starting on the second day. Duration of therapy is based on recovery from neutropenia or immunosuppression.
    • Oral suspension
      • Dosing: 200 mg (5 ml) three times a day. Duration of therapy is based on recovery from neutropenia or immunosuppression.
  • Oropharyngeal candidiasis (oral suspension only)
    • Loading dose: 100 mg (2.5 mL) twice a day on the first day
    • Maintenance: 100 mg (2.5 mL) once a day for 13 days.
  • Oropharyngeal candidiasis refractory to itraconazole and/or fluconazole (oral suspension only)
    • Dosing: 400 mg (10 mL) twice a day. Duration of therapy should be based on the severity of the patient's underlying disease and clinical response.

Other

  • Take tablet with food to enhance absorption. Take oral suspension with a full meal or with a liquid nutritional supplement or an acidic carbonated beverage (e.g., ginger ale) in patients who cannot eat a full meal.
  • Swallow tablets whole. Do not divide, crush, or chew.
  • Posaconazole is a CYP3A4 strong inhibitor and has many potential drug interactions. See Noxafil PI [sec7] and Drugs.com interactions checker for more.
  • Posaconazole is primarily metabolized via UDP glucuronosyltransferase, and it is a P-glycoprotein substrate
  • Kidney disease - no dose adjustment necessary
  • Liver disease - no dose adjustment necessary

Griseofulvin | Grifulvin V® | Gris-Peg®

Griseofulvin microsize

Tablet (Grifulvin V®)
  • 250 mg (?)
  • 500 mg ($$)
Suspension
  • 125 mg/5 ml (600 ml $$)

Griseofulvin ultramicrosize

Tablet (Gris-Peg®)
  • 125 mg ($-$$)
  • 250 mg ($$)

Dosing

Pediatric (Infants)
  • Tinea capitis
    • Griseofulvin microsize
      • 15 mg/kg once daily for 45 - 60 days
    • Griseofulvin ultramicrosize
      • 10 mg/kg once daily for 30 - 60 days
Pediatric
  • Tinea capitis
    • Griseofulvin microsize
      • 20 - 25 mg/kg once daily for 6 - 8 weeks (CTE)
    • Griseofulvin ultramicrosize
      • 10 - 15 mg/kg once daily for 6 - 8 weeks (CTE)
  • Tinea corporis
    • Griseofulvin microsize
      • 10 mg/kg once daily (max 500 mg/day) for 2 - 4 weeks (PI)
    • Griseofulvin ultramicrosize
      • 7.25 mg/kg once daily (max 375 mg/day) for 2 - 4 weeks (PI)
  • Tinea pedis
    • Griseofulvin microsize
      • 10 mg/kg once daily (max 500 mg/day) for 4 - 8 weeks (PI)
    • Griseofulvin ultramicrosize
      • 7.25 mg/kg once daily (max 375 mg/day) for 4 - 8 weeks (PI)
Adults
  • Tinea capitis
    • Griseofulvin microsize
      • 500 mg once daily for 6 - 8 weeks (CTE)
    • Griseofulvin ultramicrosize
      • 375 mg once daily for 6 - 8 weeks (CTE)
  • Tinea corporis
    • Griseofulvin microsize
      • 500 mg once daily for 2 - 4 weeks (PI)
    • Griseofulvin ultramicrosize
      • 375 mg once daily for 2 - 4 weeks (PI)
  • Tinea pedis
    • Griseofulvin microsize
      • 500 mg once daily for 4 - 8 weeks (PI)
    • Griseofulvin ultramicrosize
      • 375 mg twice daily for 4 - 8 weeks (PI)
  • Onychomycosis - toenails
    • Griseofulvin microsize
      • 500 mg once daily for 6 months (PI)
    • Griseofulvin ultramicrosize
      • 375 mg twice daily for 6 months (PI)
  • Onychomycosis - fingernails
    • Griseofulvin microsize
      • 500 mg once daily for 4 months (PI)
    • Griseofulvin ultramicrosize
      • 375 mg twice daily for 4 months (PI)

Other

  • May take without regard to food
  • Gastrointestinal upset is common
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Lab monitoring (CBC, ALT, AST) during griseofulvin treatment does not appear to be necessary in healthy patients during shorter courses of therapy (≤ 8 weeks)
  • Kidney disease - manufacturer makes no dosage recommendations
  • Liver disease - manufacturer makes no dosage recommendations

Ibrexafungerp (Brexafemme®)
Tablet
  • 150 mg ($$$$)
  • Comes in carton with 4 tablets

Dosing

Vulvovaginal candidiasis (adults and postmenarchal pediatric females)
  • Dosing: two 300 mg doses (two 150 mg tablets) given 12 hours apart
  • May take without regard to food
  • DO NOT GIVE in pregnancy
  • See yeast infections for more
Reduction in the incidence of recurrent vulvovaginal candidiasis
  • Dosing: two 300 mg doses (two 150 mg tablets) given 12 hours apart for one day every month for six months
  • May take without regard to food
  • DO NOT GIVE in pregnancy
  • See recurrent yeast infections for more
With CYP3A4 strong inhibitors
  • Dosing: two 150 mg doses given 12 hours apart
  • See CYP3A4 inhibitors
  • No dose adjustment necessary with weak or moderate CYP3A4 inhibitors

Other

  • PREGNANCY - DO NOT GIVE. May cause fetal harm. Confirm that the patient is not pregnant before each dose. Patients should use contraception throughout the treatment period and for 4 days after the last dose.
  • Ibrexafungerp is a triterpenoid antifungal that works by inhibiting glucan synthase, an enzyme involved in the formation of 1,3-β-D-glucan, an essential component of the fungal cell wall
  • Ibrexafungerp is a CYP3A4 sensitive substrate. Reduce dose when given with CYP3A4 strong inhibitors (see above). It is not recommended with strong or moderate CYP3A4 inducers.
  • Kidney disease - manufacturer makes no recommendation
  • Liver disease
    • Child-Pugh A/B: no dose adjustment necessary
    • Child-Pugh C: has not been studied

Studies



Pricing legend
  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • Pricing based on one month of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability