Antifungal Medications Used in Dentistry

Here the Antifungal Medications Used in Dentistry with trade names, indications, dosage, side-effects & drug interactions

Nystatin 

Trade Name:

Mycostatin pastilles

Mycostatin oral suspension 

Indications:

Oral candidiasis 

Dosage:

One or two pastilles (200,000-400,000 units) dissolved slowly in the mouth 4 to 5 times daily for 10 to 14 days 

Side effects/Adverse Reactions:

This Antifungal medications can cause Nausea, diarrhea, vomiting with large doses 

Drug interactions:

None known 

Clotrimazole 

Trade Name:

1. Mycelex oral troches

2. Candid mouth paint 

Indications:

Oral candidiasis 

Dosage:

1. Dissolve 1 troche (10 mg) slowly in the mouth, 5 times daily for 10 to 14 days 
2. Apply topically 3-4 times a day

Side effects/Adverse Reactions:

Mild elevations of liver enzymes in 15% of patients, Periodic assessment of liver function in patients with hepatic impairment, Nausea, vomiting 

Drug interactions:

No significant drug interactions 

Ketoconazole  

Trade Name:

Nizoral tablets 

Indications:

1. Oral candidiasis, Blastomycosis, 

2. Coccidioidomycosis Histoplasmosis Paracoccidioidomycosis 

Dosage:

1. Not to be used as initial therapy for oral candidiasis. One tablet (200 mg) daily for 1 to 2 weeks for candidiasis
2. Minimum treatment period for systemic mycoses is 6 months 

Side effects/Adverse Reactions:

1. Serious hepatotoxicity in 1 : 10,000 patients
Monitoring of liver function is indicated for patients with preexisting hepatic problems, patients who develop symptoms of hepatic failure, or patients treated for more than 28 days 

2. Serum testosterone is lowered 

Nausea, vomiting
Anaphylaxis 

Drug interactions:

Serious and/or life-threatening interactions with erythromycin. Metabolism of cyclosporine, tacrolimus, methylprednisolone, midazolam, triazolam, coumarin-like drugs, phenytoin, and rifampin may be altered 

Fluconazole 

Trade Name:

Diflucan tablets

Indications:

Oral candidiasis, Cryptococcal meningitis 

Dosage:

For oral candidiasis: two tablets (200 mg) on day 1 and then one tablet (100 mg) daily for 1 to 2 weeks.

Side effects/Adverse Reactions:

Rare cases of hepatotoxicity, ranging from mild transient elevation of liver enzymes to hepatic failure, Headache, nausea, vomiting, abdominal pain, diarrhea 

Drug interactions:

Clinically or potentially significant side effects have been noted with the following medications: oral hypoglycemic agents, coumarin-like drugs, phenytoin, cyclosporine, rifampin, theophylline, rifabutin, and tacrolimus 

Itraconazole  

Trade Name:

Sporanox capsules 

Indications:

1. Blastomycosis Histoplasmosis 

2. Aspergillosis refractory to amphotericin B therapy 

Dosage:

1. For blastomycosis and histoplasmosis: two capsules (200 mg) daily, increasing by 100-mg increments up to 400 mg daily in divided doses if no clinical response is noted.
2. For aspergillosis: 200 to 400 mg daily 
3. For life-threatening situations: loading dose of 200 mg t.i.d. for first 3 days, then dose can be reduced. 
4. Treatment should continue for at least 3 months for all of the above 

Side effects/Adverse Reactions:

Rare cases of hepatoxicity 

Liver function should be monitored in patients with preexisting hepatic problems on therapy for more than 1 month 

Nausea, diarrhea, vomiting

Drug interactions:

Serious and/or life-threatening interactions with erythromycin, pimozide, quinidine, oral triazolam, and oral midazolam 

Lovastatin and simvastatin should be discontinued 

Increased plasma concentrations may be seen with warfarin, ritonavir, indinavir, vinca alkaloid agents, diazepam, cyclosporine, dihydropyridine medications, tacrolimus, digoxin, and methylprednisolone 

Itraconazole 

Trade Name:

Sporanox oral solution 

Indications:

Oral candidiasis 

Dosage:

10 mL (100 mg) vigorously swished in the mouth and swallowed, twice daily for 1 to 2 weeks.

Side effects/Adverse Reactions:

This Antifungal medications can cases of hepatotoxicity but it is very rare.

Liver function should be monitored in patients with preexisting hepatic problems on therapy for more than 1 month 

Nausea, diarrhea, vomiting 

Drug interactions:

Serious and/or life-threatening interactions with erythromycin, oral triazolam, and oral midazolam,

Lovastatin and simvastatin should be discontinued 

Amphotericin B 

Trade Name:

Fungizone oral suspension 

Indications:

Oral candidiasis 

Dosage:

1 mL (100 mg) rinse and hold in the mouth for as long as possible, q.i.d., p.c., and h.s. for 2 weeks

Side effects/Adverse Reactions:

Rash, gastrointestinal symptoms 

Drug interactions:

No significant drug interactions