MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Antifungals

These are the antimicrobials used within MTW NHS Trust and West Kent CCG, please refer to the appropriate Antimicrobial guidelines for guidance on the choice of antimicrobial for different indications.

Drug Safety Update

 May 2014: Voriconazole: reminder of risk of liver toxicity, phototoxicity and squamous cell carcinoma.

 July 2018: Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused

July 2020: Liposomal and lipid-complex formulations: name change to reduce medication errors

Never interchange liposomal, pegylated-liposomal, lipid-complex, and conventional formulations that contain the same drug substance

October 2020: Flucytosine (Ancotil): new contraindication in patients with DPD deficiency

Important Safety Information

Heart failure - itraconazole

Following reports of heart failure, caution is advised when prescribing itraconazole to patients at high risk of heart failure. Those at risk include:

  • patients receiving high doses and longer treatment courses;
  • older adults and those with cardiac disease;
  • patients with chronic lung disease (including chronic obstructive pulmonary disease) associated with pulmonary hypertension;
  • patients receiving treatment with negative inotropic drugs, e.g. calcium channel blockers.

Itraconazole should be avoided in patients with ventricular dysfunction or a history of heart failure unless the infection is serious.

Hepatotoxicity

Fluconazole: Monitor liver function with high doses or extended courses—discontinue if signs or symptoms of hepatic disease (risk of hepatic necrosis).

Itraconazole: Potentially life-threatening hepatotoxicity reported very rarelydiscontinue if signs of hepatitis develop. Caution if history of hepatotoxicity/active liver disease or receiving other hepatotoxic drugs

Voriconazole: Hepatitis, cholestasis, and acute hepatic failure have been reported; risk of hepatotoxicity increased in patients with haematological malignancy. Consider treatment discontinuation if severe abnormalities in liver function tests.

Triazole antifungals (e.g. fluconazole, itraconazole, voriconazole) have the potential to interact with a wide variety of drugs please check BNF for details

Pack Price
14 tablet £1.75
28 tablet (2 x 14 tablets) £3.50
Pack Price
15 capsule (3 x 5 capsules) £4.88
60 capsule £19.52
Pack Price
150 ml £59.28
Pack Price
28 tablet (4 x 7 tablets) £161.83
Pack Price
28 tablet £634.04
Pack Price
75 ml £551.37
Pack Price
1 vial

Posaconazole liquid and tablets doses are NOT interchangeable – always specify formulation on prescriptions and check dosage

Posaconazole is used in adult haemo-oncology patients only mainly for antifungal prophylaxis 

Pack Price
105 ml £491.20
Pack Price
24 tablet (2 x 12 tablets) £596.96

Flucytosine is used for adult haemo-oncology patients only 

Pack Price
5 bottle £151.67