ANTIFUNGALS

**ANTIFUNGAL**

An //**antifungal**// is a medication that inhibits the growth of fungus, kills it or prevents it from forming. A common example of such a fungus would be yeast. antifungal works by attacking the cells of the fungus, either killing it or preventing it from reproducing. One drug in particular is called flucytosine, which acts by directly penetrating the cells of the fungus and slowing down reproduction and growth rates. Another drug, called clotrimazole acts by punching holes in the cell walls of the fungus, causing important components to fall out. Without these components, the cells cannot reproduce, and therefore the fungus dies. Fungal infections are fairly common and with antifungal medication, many people report relief of uncomfortable symptoms caused by the fungi growth. Antifungal medications come in a variety of forms for a variety of fungal ailments including:
 * //Topical:// These antifungal medications are typically in cream form and are applied directly to the affected area. Such antifungals are commonly used to treat nail fungal infections and similar ailments.
 * //Oral:// People who suffer from a yeast infection of the mouth will often be required to take oral medication to treat the fungus.
 * //Suppositories:// Vaginal yeast infections are commonly treated by way of suppositories, which dissolve and release a topical cream that eliminates the fungus by killing it.

__**Indications:**__ //**> systemic fungal infections (candidiasis, blastomycosis, coccidioidomycosis, histoplasmosis)** -// these occur when fungi get into the bloodstream and generally cause more serious diseases. Systemic fungal infections may be caused either by an opportunistic organism that attacks a person with a weakened immune system, or by an invasive organism that is common in a specific geographic area, such as cocci and histoplasma. Unlike superficial infections, systemic fungal infections can be life-threatening.

//> **tinea infections of the skin, hair, nail unresponsive to topical** - ringworm//, which isn't a worm at all, is a fungus infection that can affect the skin, nails, or scalp. //Tinea// fungi can infect the skin and related tissues of the body. The medical name for ringworm of the scalp is //tinea capitis//; ringworm of the body is called //tinea corporis//; and ringworm of the nails is called //tinea unguium//. With tinea corporis, the fungi can cause scaly, ring-like lesions anywhere on the body.

//> **cryptococcal meningitis**// - is a brain infection caused by a fungus called cryptococcus neoformans, which is found mainly in dirt and bird droppings. //>// //**severe recalcitrant dermatophyte infections unresponsive to topical**// //**> onychomycosis**// - fungal infection of the finger or toe nails which is very difficult to cure


 * __1. G.N:Clotrimazole__

Brand Name:**  > - Lotion: Clotrimazole 1% Desenex* Lotrimin* > - Solution: Clotrimazole 1% Desenex*  
 * Canesten* Bayer
 * Mycelex* Bayer
 * Desenex* Novartis
 * Dosage Forms**:
 * **Lozenges:** Clotrimazole 10 mg Mycelex*
 * **Topical:** Cream: Clotrimazole 1% Desenex* Lotrimin*
 * Used for:**
 * Tinea corporis
 * Tinea cruris
 * Tinea pedis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Pityriasis versicolor
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Cutaneous candidiasis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Nail and skin infections, fungal or gram positive
 * Therapuetic regimen:**
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Adult** || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Pediatric** ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Dermatomycoses

Clotrimazole 1% cream, solution, or lotion bid x14-28d, apply in a thin layer to the affected area and surrounding skin. || * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Topical preparations should not be used in children < 2 years old
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Vaginal preparations are not recommended for children < 12 years old
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Lozenges should not be used in children < 5 years old ||

== Adverse Effect: <span style="color: #5100ff; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">//Local cutaneous effects// may include irritation, hypersensitivity, burning, pruritus, erythema, fissuring, or swelling. **FDA Pregnancy Category C** Oral formulation shows toxicity in animal trials. Use is not recommended during pregnancy or lactation. **__2.G.N:Ciclopirox__** ==

<span style="color: #5100ff; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Trade Name:

 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Penlac* Dermik
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Loprox* Dermik

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Dosage Forms:
<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">The topical application of this drug was one of the first effective antifungals for superficial dermatophyte, yeast, and fungal infections. The most recent formulation, a lacquer, has made ciclopirox convenient in the treatment of nail infections.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Nail lacquer solution:** Ciclopirox olamine 8% Penlac Nail Lacquer*
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Topical Gel:** Ciclopirox olamine 1% Loprox*
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Cream:** Ciclopirox olamine 1% Loprox*
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Lotion:** Ciclopirox olamine 1% Loprox*

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Used for

 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Tinea corporis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Tinea cruris
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Tinea pedis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Tinea versicolor
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Candidiasis, cutaneous
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Nail lacquer-
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Onychomycosis

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Therapeutic Regimen

 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Adult** || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Pediatric** ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Ciclopirox 1%** lotion, gel or cream applied to the affected areas twice a day.


 * Ciclopirox 8%** nail lacquer to be applied daily as directed and removed once a week. Continue up to 48 weeks if necessary. || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">PediatricSafety and efficacy have not been established for children < 10 years of age. ||

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Safety Information
<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Adverse Effects** Cutaneous effects may include local irritation or burning when first applied.


 * FDA Pregnancy Category B** Adequate human studies have not been completed. Animal studies have not shown adverse fetal effects. It is not known if ciclopirox is distributed in breast milk.


 * __3.G.N:Ketoconazole__**

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Trade Name:

 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Nizoral* Janssen

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Dosage Forms:

 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Topical: Cream:** Ketoconazole cream 2% Nizoral*
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Shampoo:** Ketoconazole shampoo 1% and 2% Nizoral Shampoo*
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Oral: Tablets:** Ketoconazole tablets 200 mg
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Suspension:** Ketoconazole oral suspension 100mg/5mL Nizoral*

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Uses
<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Systemic Tinea corporis, cruris, pedis, severe and unresponsive to Griseofulvin therapy * Chromomycosis <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Other (selection) * Paracoccidiomycosis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Labeled Indications** || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Off-Label Uses** ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Topical
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Tinea corporis, cruris, pedis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Pityriasis versicolor
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Cutaneous candidiasis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Seborrehic dermatitis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Dandruff
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Chronic mucoutaneous candidiasis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Candidiasis, oropharyngeal
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Candidiasis, systemic || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Systemic * OnychomycosisParonychia #
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Leishmaniasis, cutaneous #
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Candidiasis, vulvo-vaginal # ||

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> # - not included in Canadian product labeling

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Therapeutic Regimen
<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Other antifungal indications** Ketoconazole 200-400mg po daily. * Therapy to be continued for 1-2 weeks in candidal infections; for 1- 8 weeks in dermatophytes; and for 6 months or longer in systemic mycoses Topical * Dandruff <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Seborrehic dermatitis*** Ketoconazole 2% shampoo or cream twice a week for 2-4 weeks. Apply to the hair and scalp, leave for 5 minutes and wash off > <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">2 years of age * **Ketoconazole 3.3-6.6 mg/kg po daily** <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Vulvovaginal candidiasis * Ketoconazole 5-10 mg/kg po daily yx5d Paronychia * **Ketoconazole 5-10 mg/kg po daily** Topical * Safety and efficacy have not been established for topical use ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Adult** || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Pediatric** ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Systemic
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Pityriasis versicolor
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Ketoconazole 200mg po daily x5-10d
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Ketoconazole 1% shampoo every 3-4 days for up to 8 weeks
 * Pityriasis versicolor*** Ketoconazole 2% shampoo single application to the affected areas and surrounding skin. Leave for 5 minutes and rinse.
 * Tinea corporis, cruris, pedis and cutaneous candidiasis*** Ketoconazole 2% cream applied to the affected areas, and surrounding skin once a day until clear. || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Systemic * Safety and efficacy have not been established for systemic use in children < 2 years of age

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Side Effects:
<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**FDA Pregnancy Category C** Animal studies have shown teratogenicity and embryonic toxicity when given very high oral doses. Use of ketoconazole is not recommended during pregnancy or lactation.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Local cutaneous effects may include itching, stinging, irritation or contact dermatitis.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Cutaneous effects may include hypersensitivity reactions including exfoliative dermatitis and Stevens-Johnson syndrome
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Gastrointestinal effects may include nausea, abdominal pain, diarrhea, constipation, loss of appetite and rarely, hepatotoxicity.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Hematologic effects may include agranulocytosis or thrombocytopenia.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Other effects may include headache, dizziness and drowsiness. Azospermia, impotence, decreased libido in menstrual irregularities may occur as a result of corticosteroid and testosterone suppression.


 * __4.G.N: Terbinafine hydrochloride__**

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Trade Name:

 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Lamisil* Novartis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Lamisil DermGel* Novartis
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Lamisil AT* Novartis

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Dosage Types;
> Lamisil* and Lamisil AT <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Topical: Cream:** Terbinafine hydrochloride 1% *
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Solution:** Terbinafine hydrochloride Lamisil
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Oral: Tablets:** Terbinafine hydrochloride tablets 250 mg Lamisil*

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%; text-align: left;">Therapeutic Regimen
<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Tinea cruris, corporis and pedis** * Lamisil 250 mg po daily x2-6 weeks Topical <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Tinea pedis*** Lamisil 1% 2x/d x2 weeks until significant improvement shows. <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Tinea versicolor.*** Lamisil 1% 1-2x/d x2 weeks until significant improvement shows. <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Cutaneous candidiasis** * Lamisil 1% 1-2x/d x1-2 weeks until significant improvement shows. Topical * Safety and efficacy have not been established in children < 12 years of ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Adult** || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">**Pediatric** ||
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Oral
 * Onychomycosis**
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Lamisil 250 mg po daily x6 weeks for the fingernails, and x12 weeks for the toenails.
 * Tinea corporis and cruris*** Lamisil 1% 1-2x/d x1 week until significant improvement shows.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Treatment should not be continued after 4 weeks.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Treatment should not be continued after 4 weeks.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Treatment should not be continued after 4 weeks.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Treatment should not be continued after 4 weeks. || <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> Oral * Safety and efficacy have not been established

<span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;"> **Adverse Effects** <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">** FDA Pregnancy Category B ** Human tests have not been completed, but animal testing has not shown any adverse fetal effects. Terbinafine is distributed in the breast milk. Treatment during pregnancy and lactation is not recommended.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Local cutaneous effects may include mild burning, irritation, and erythema.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Cutaneous effects may include hypersensitivity reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Gastrointestinal effects may include nausea, dyspepsia, stomach pain, reversible loss of taste and hepatitis.
 * <span style="color: #4c1098; display: block; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; text-align: left;">Hematologic effects may include neutropenia and pancytopenia.

5. **__G.N: Caspofungin__**

> > **Therapeutic Regimen:** There is no sufficient clinical experience to judge the safety and efficacy in patients younger than 18 years of age. || > **Warning:** > **Hepatic Effects** Dosage reduction in patients with moderately impaired liver function is recommended. No clinical data exists regarding the use of caspofungin in patients with severely impaired liver function.** >** > Side Effects: >** > FDA Pregnancy Category C The drug is found in the milk of lactating rats; it is not known, whether this effect can be seen in women, too. Lactating women should be treated cautiously.** > > > **Trade Name:** > > *** Mycamine __6. Micafungin__** > > Dosage Forms:
 * Trade Name:**
 * Cancidas
 * Dosage Types**:
 * Cancidas 50mg for i.v.-infusion (manufacturer Merck)
 * Cancidas 70mg for i.v.-infusion (manufacturer Merck)
 * **Adult** || **Pediatric**
 * The concomitant use of caspofungin and cyclosporine in healthy volunteers led to a more frequent increase of liver enzymes (ALT=SGPT and AST=SGOT) than noted with cyclosporine alone. Combination treatment is only indicated, if the potential benefit for the patient outweighs the potential risk.
 * **Sensitivity Reactions**
 * Reactions due to histamine release (rash, facial swelling, pruritus, sensation of warmth and one case of anaphylaxis) have been seen. Those reactions should be carefully watched for.**
 * **Drug Resistance**
 * In a few patients with infections caused by C. albicans mutants with reduced sensitivity to caspofungin have been noticed. Currently there is no data regarding development of resistance in other fungi than C. albicans.
 * Compared to amphotericin B, caspofungin seems to have a relatively low incidence of side-effects. In clinical studies and post-marketing reports the side-effects seen in 1% or more of the patients were as follows:**
 * **[|Gastrointestinal system] : [|nausea], [|vomiting], [|abdominal pain], and [|diarrhea]**
 * **[|Central nervous system] : [|headache]**
 * **Whole body : [|fever], [|phlebitis] or thrombophlebitis, complications at [|intravenous cannulation] site (e.g. induration), unspecified pain, [|flu-like syndrome], myalgia, chills, and [|paresthesia]**
 * **[|Respiratory] : [|dyspnea]**
 * **[|Renal] : increased plasma [|creatinine]**
 * **[|Hematological] : [|anemia]<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%;"> **
 * **[|Electrolytes] : [|hypokalemia]**
 * **[|Liver] : increased [|liver enzymes] (asymptomatic)**
 * **[|Hypersensitivity] : rash, facial edema, [|pruritus]**
 * **Others : [|tachycardia]**
 * Additionally, infrequent cases of symptomatic liver damage, peripheral edema and swelling, and [|hypercalcemia] have been seen. One case of [|anaphylaxis] (severe allergic reaction) has also been noted.
 * Caspofungin has in animal studies been shown to have embroyotoxic properties and therefore has been assigned to class C. It should only be given to pregnant women, if the benefit to the mother clearly outweighs the potential risk to the unborn.

> > Dosage: > Contraindications: Known hypersensitivity to micafungin or any other ingredient contained in the formulation.** > <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%;">FDA Pregnancy Category C
 * **Mycamine 50mg for i.v.-infusion (manufacturer Astellas)**
 * **Mycamine 100mg for i.v.-infusion (manufacturer Astellas)**
 * For the treatment of candidemia, acute disseminated candidiasis, candida peritonitis and abscesses, the dosage of micafungin is 100 mg once daily. For the treatment of esophageal candidiasis, the dosage is 150 mg once daily. For prophylaxis of candida infections in HSCT recipients, the dosage is 50 mg once daily.**

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