- Allylamines
- Azoles
- Imidazoles
- Triazoles
- Polyenes
- Echinocandins
- Other antifungal drugs
Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch
Allylamines
| Generic name | Brand name |
|---|---|
| Amorolfin | Locery® (nail lacquer) |
| Butenafine | Lotrimin® Ultra (cream, spray), Mentax® (cream) |
| Naftifine | Naftin® (cream, gel) |
| Terbinafine | Lamisil® (cream, gel, spray, solution, oral granules, tablets) |
Allylamines are synthetic antifungals with activity against a wide range of dermatophytes. Allylamines act via inhibition of the squalene epoxidase formation, which blocks the synthesis of ergosterol.
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Allylamines (with the exception of terbinafine) are used as topical treatments. Oral terbinafine is extensively used for the treatment of onychomycosis (fungal infection of the nail). It acts at an earlier stage by inhibiting the formation of squalene epoxide, a precursor of lanosterol. Oral terbinafine is the first choice for treating infections of fingernails and toenails.
Azoles
Azoles (imidazole and triazole derivatives) are a large group of synthetic antifungal agents. Azoles are essentially fungistatic, and have a relatively broad antifungal spectrum. The azole antifungals have many drug-drug interactions because of their interference with cytochrome P-450 enzymes.
Imidazoles are considered first-line agents for most dermatophyte infections. Topical formulations are widely used for the treatment of superficial fungal infections and vaginal candidiasis. Imidazoles are very toxic when taken orally, so they are available only as topical formulations.
Triazoles are generally used for prophylaxis and treatment of invasive fungal infections and systemic mycosis.
Arylguanidines are a novel class of synthetic antifungal drugs.
Polyenes
| Generic name | Brand name |
|---|---|
| Amphotericin B | Fungilin® (lozenges, oral suspension) |
| Nystatin | Nilstat® (oral drops, capsules, powder, tablets) |
| Natamycin (pimaricin) | |
| Trichomycin (hachimycin) |
The polyenes are naturally occurring compounds with a very broad antifungal spectrum. Polyenes act by binding to sterols in the fungal cell membrane, thereby interfering with membrane integrity and causing leakage of essential metabolites. Most polyenes are used topically, but intravenous amphotericin remains an important agent for the treatment of systemic fungal infections. The risk of nephrotoxicity limits the use of amphotericin B.
Echinocandins
| Generic name | Brand name |
|---|---|
| Anidulafungin | Eraxisin® injection |
| Caspofungin | Cancidas® injection |
| Micafungin | Mycamine® injection |
Echinocandins are the most recently developed class of antifungals. Echinocandins are used mainly for the treatment of severe, invasive Candida infections. Echinocandins are safer than other classes of antifungals and have a broad spectrum, and synergistic effect in combination therapy.
Miscellaneous Antifungal Drugs
| Generic name | Brand name |
|---|---|
| Thiocarbamates | |
| Tolnaftate | Tinactin®, Aftate®, Breezee®, Ting® |
| Antimetabolites | |
| Flucytosine | |
| Benzylamines | |
| Butenafine | Mentax® (cream), Lotrimin® (cream) |
| Other antifungals | |
| Griseofulvin | Gris-PEG® (tablets), Grifulvin® V (tablets), Grisactin® |
| Ciclopirox | Ciclodan® (cream, solution, topical suspension), Loprox® (cream), Penlac® (solution, nail lacquer), Loprox® (topical suspension, gel, shampoo) |
| Selenium sulfide | Selsun®, Exsel® |
| Tavaborole | Kerydin® |
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Further reading
- Fluconazole vs Terbinafine
Resources
- 1. New FDA Approved Drugs CenterWatch
Originally published: September 12, 2017
Last updated: December 04, 2018
