Elevated liver enzymes, hepatotoxicity (rare but serious)
Cardiac failure (rare, with itraconazole)
2. Terbinafine
Example:
Terbinafine (e.g., Lamisil)
Terbinafine PBS indications
Treatment of fungal skin infections and onychomycosis (nail fungus) where topical therapy has failed or is inappropriate.
Particularly useful in cases of dermatophyte (tinea) infections.
Side Effects:
Gastrointestinal upset (diarrhea, dyspepsia)
Headache
Rash, urticaria
Changes in taste or loss of taste, which is usually reversible
Elevated liver enzymes, hepatotoxicity (less common but can be serious)
Blood dyscrasias (rare)
3. Griseofulvin
Griseofulvin (e.g., Grifulvin V, Gris-PEG)
PBS indications
Treatment of dermatophyte infections of the skin, hair, and nails where topical therapy is inappropriate or has failed.
Often used in cases where the fungal infection is extensive, deep, or difficult to treat with topical agents alone.
Side Effects:
Gastrointestinal discomfort
Headaches
Photosensitivity
Hepatotoxicity
Blood dyscrasias
Teratogenic effects (not recommended during pregnancy)
Monitoring and Considerations
Liver Function: Since many oral antifungals can affect liver function, liver enzymes should be monitored before and during treatment, especially in patients with pre-existing liver conditions or those taking other hepatotoxic drugs.
Kidney Function: Monitoring may be required, especially in patients with renal impairment.
Drug Interactions: Oral antifungals can interact with a variety of other medications. For example, they can increase the concentration of certain drugs like warfarin, leading to an increased risk of bleeding.
Allergic Reactions: Although rare, severe allergic reactions can occur.
Pregnancy and Breastfeeding: Some antifungals are contraindicated during pregnancy and breastfeeding.