Fluconazole, Terbinafine, and More: 8 Oral Antifungal Medications and How They Differ
Key takeaways:
Oral antifungal medications are prescribed for serious fungal infections. They’re also a second-choice option if a topical antifungal isn’t effective on its own.
The type of oral antifungal you’re prescribed depends on what type of infection you’re taking it for. It also depends on your other medications and health conditions. Your healthcare team can help you decide on the best treatment option for your needs.
There are several ways to save on your oral antifungal medications. Many options are available as lower-cost generics. GoodRx can help make your prescription more affordable.
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Table of contents
Fungal infections often appear in science fiction. But they’re more common in real life than you may think. Some fungal infections, such as athlete’s foot, are typically mild and easy to treat. But others can be serious or even life-threatening.
If you have a fungal infection that’s widespread or isn’t responding to topical treatments, your prescriber may suggest an oral antifungal medication. Here, we’ll look at eight common oral antifungal medications and how they differ.
Good to know: Many oral antifungal medications also come in topical and injectable formulations. This article will only focus on the oral forms of these medications.
1. Fluconazole (Diflucan)
Fluconazole (Diflucan) is one of the most commonly prescribed oral antifungal medications. It’s an azole antifungal that treats Candida (yeast) infections. These include vaginal yeast infections and oral thrush. Fluconazole can also be used to treat fungal meningitis and to prevent fungal infections in people with a weakened immune system. It’s approved for adults and children age 6 months and older.
Fluconazole comes as a tablet and an oral suspension. Fluconazole blocks certain enzymes (proteins) in your liver that break down medications. So it can interact with other medications you’re taking. Be sure to show your current medication list to your healthcare team to make sure fluconazole is a safe option for you.
Common fluconazole side effects include nausea, headache, and diarrhea. You can take fluconazole with or without food. But if it upsets your stomach, taking it with food may help.
How to save: Fluconazole is available as both a brand-name and generic medication. Generic fluconazole’s price at certain pharmacies is as low as $10.42 with a free GoodRx discount.
2. Terbinafine (Lamisil)
Terbinafine (Lamisil) is one of the most effective oral treatments for onychomycosis (a fungal nail infection). It’s also often prescribed off-label for tinea infections when topical treatments aren’t effective. Common tinea infections include ringworm, athlete’s foot, and jock itch.
Over-the-counter antifungal creams: If you’re looking for a treatment option you don’t need a prescription for, these antifungal creams are your best bet.
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Terbinafine comes as a once-daily oral tablet and is only approved for adults. You can take it with or without food, but taking it with a meal can help manage nausea. Keep in mind that it takes time to treat a nail infection, so you may need to take terbinafine for up to 12 weeks.
Terbinafine side effects are usually mild and include headache, diarrhea, and upset stomach. But in rare cases, terbinafine can cause liver damage. So your prescriber will likely check your liver function before starting it and during treatment. Like many other oral antifungals, it also has a large number of drug interactions to consider before taking it.
How to save: Terbinafine is only available as a generic medication. You can pay as little as $14.34 for a 30-day supply with a free discount from GoodRx.
3. Itraconazole (Sporanox)
Itraconazole (Sporanox, Tolsura) is another azole antifungal. It can be used for a wide range of fungal infections, including oral thrush. Like terbinafine, itraconazole treats nail fungus and is often prescribed off-label for tinea infections when other treatments haven’t worked. It also treats more serious fungal infections, such as histoplasmosis and blastomycosis. These conditions involve fungal infections in the lungs, bones, or bloodstream.
Itraconazole is only FDA-approved for adults. But it’s often prescribed off-label for children age 6 months and older. It comes as an oral solution and two different types of oral capsules. Each dosage form is approved for different fungal infections, and they aren’t interchangeable. So be sure to follow your prescriber’s instructions carefully. You should take the oral solution on an empty stomach, while the capsules should be taken with food.
The most common itraconazole side effects are nausea, vomiting, and diarrhea. But it also has a boxed warning about the risk of heart failure while taking it. This is the FDA’s most serious type of warning. Like fluconazole, itraconazole can interact with many other medications.
How to save: Itraconazole is available as both a brand-name and generic medication. Generic itraconazole’s price is as low as $26.00 for a 30-day supply of capsules. If you have commercial insurance, you may pay as little as $0 per month for brand-name Tolsura using a copay card from the manufacturer.
4. Nystatin
Nystatin is an older antifungal medication that comes as an oral tablet and an oral suspension (liquid). The suspension treats oral thrush, while the tablet treats Candida infections of the stomach or intestines.
Nystatin suspension is one of the few antifungal medications that’s considered safe for infants and young children. It’s also a common ingredient in a compounded medication known as “magic mouthwash.” This custom mouthwash helps treat and prevent oral thrush and mouth sores.
Your body doesn’t absorb nystatin into the bloodstream after you take it. So even though it’s an oral medication, it works more like a topical treatment inside the mouth, stomach, and intestines. This means it typically has fewer side effects and drug interactions than other antifungals. But it’s not effective for widespread fungal infections.
How to save: Nystatin only comes as a lower-cost generic. You can pay as little as $6.46 for a 60 mL bottle of nystatin suspension or $24.99 for 60 nystatin tablets with a free discount from GoodRx.
5. Ketoconazole (Nizoral)
Ketoconazole is an azole antifungal that’s typically only prescribed when other antifungal medications aren’t an option. It treats serious, body-wide fungal infections and shouldn’t be prescribed for nail, skin, or Candida infections. Ketoconazole can be prescribed for adults and children age 2 and older.
Ketoconazole comes as an oral tablet. In most cases, you’ll take it for a long period of time (about 6 months). Your body absorbs ketoconazole best in an acidic environment. Taking it with orange juice or soda can help it work properly, especially if you’re taking medication that reduces stomach acid.
Like other azole antifungals, ketoconazole has a large number of drug interactions to consider. Serious side effects are possible with ketoconazole. These include liver- and heart-related issues. These risks are the main reason ketoconazole is only prescribed when other treatments aren’t effective.
How to save: Ketoconazole is only available as a lower-cost generic. A free GoodRx discount can help you pay as little as $24.00 for a 30-day supply of ketoconazole tablets at certain pharmacies.
6. Voriconazole (Vfend)
Voriconazole (Vfend) is used for serious fungal infections, such as invasive aspergillosis (a fungal infection in the lungs) and candidemia (a fungal infection in the blood). It’s approved for adults and children age 2 and older.
Voriconazole comes as an oral tablet, an oral suspension, and an injection. In most cases, you’ll begin treatment with the injectable form of voriconazole in a hospital setting. You’ll then switch to one of the oral forms to finish your treatment course as your symptoms improve.
As with other azole antifungals, voriconazole has a large number of drug interactions to consider. Common side effects include visual changes, nausea, and rash. More serious side effects are also possible, including heart and liver problems. Voriconazole can also make you more sensitive to the sun, so be sure to wear sunscreen or take other steps to protect your skin while you’re taking it.
How to save: Voriconazole is available as both a brand-name medication and a lower-cost generic. A free GoodRx discount can help you pay as little as $76.70 for a 30-day supply of generic voriconazole tablets.
7. Clotrimazole
Clotrimazole is a unique azole antifungal. It doesn’t come as a liquid or tablet that you swallow. Instead, it comes as a troche (lozenge) that slowly dissolves in your mouth. Clotrimazole lozenges help treat and prevent oral thrush. They’re often prescribed for immunocompromised people, such as those receiving cancer treatment or an organ transplant.
Clotrimazole lozenges are typically well tolerated, and they’re considered safe for adults and children age 3 and older. But they may cause side effects such as nausea or an unpleasant feeling in your mouth. Like nystatin, clotrimazole isn’t well absorbed into your bloodstream. So it doesn’t have notable drug interactions or serious risks in most cases.
How to save: GoodRx can help you save on the cost of clotrimazole lozenges, which are only available as a lower-cost generic. You can pay as little as $33.20 for a 14-day supply with a free GoodRx discount at certain pharmacies.
8. Griseofulvin
Griseofulvin is an oral antifungal that only treats tinea infections caused by specific fungi. It’s not effective for other types of fungal infections. And it shouldn’t be prescribed for infections that can be treated with a topical antifungal. Griseofulvin is approved for adults and children over the age of 2.
Griseofulvin comes as an oral tablet and oral suspension. It also comes as an ultramicrosize tablet (Gris-PEG) that can be swallowed whole or crushed and sprinkled onto a spoonful of applesauce. You should take griseofulvin with a high-fat meal. You may need to take it for up to 6 months depending on what you’re taking it for.
Common griseofulvin side effects include nausea, skin rashes, and numbness or tingling of the hands and feet. In rare cases, severe skin and liver problems can happen. Griseofulvin has fewer drug interactions than other antifungal medications. But it can make birth control pills less effective. It can also cause severe reactions, including vomiting and loss of consciousness, if you drink alcohol while you’re taking it.
How to save: Griseofulvin is available as a lower-cost generic. With a free discount, GoodRx can help you save over 70% on a 30-day supply of griseofulvin oral suspension or ultramicrosize tablets at certain pharmacies.
Is an oral antifungal better than a topical antifungal?
It depends on what type of fungal infection you’re treating. Topical antifungals, such as creams and ointments, are typically first-choice options for infections that involve the skin, hair, or nails. This is because they deliver the medication to the site of the infection with a lower risk of side effects and drug interactions.
Oral antifungals treat more serious or wide-spread infections. You may also need an oral antifungal if a topical antifungal doesn’t work. Oral treatments are considered more powerful than topical ones. But oral antifungals have more risks and interactions to consider. Your healthcare team can help you decide on the best treatment option for your needs.
The bottom line
Oral antifungal medications are typically prescribed for serious, body-wide fungal infections. They’re also a second-choice option if a topical antifungal doesn’t work on its own. The type of oral antifungal you take depends on what type of fungal infection you’re treating. It will also depend on your current medications and other health conditions. Your healthcare team will help you weigh the risks and benefits of your options to find the right treatment for you.
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