Antifungal agents

Drug_Mechanism of action_Adverse effects _Notes| Azoles _ Inhibits 14#alpha#-demethylase which produces ergosterol _ P450 inhibition Liver toxicity_| Amphotericin B _ Binds with ergosterol forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl) leakage _ Nephrotoxicity, flu-like symptoms, hypokalaemia, hypomagnaseamia _ Used for systemic fungal infections| Terbinafine _ Inhibits squalene epoxidase_ _Commonly used in oral form to treat fungal nail infections| Griseofulvin _ Interacts with microtubules to disrupt mitotic spindle _ Induces P450 system, teratogenic _ | Flucytosine _ Converted by cytosine deaminase to 5-fluorouracil, which inhibits thymidylate synthase and disrupts fungal protein synthesis _ Vomiting _ | Caspofungin _ Inhibits synthesis of beta-glucan, a major fungal cell wall component _ Flushing _| Nystatin _ Binds with ergosterol forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl) leakage _ _ As very toxic can only be used topically (e.g. for oral thrush)|