Bipolar Disorder Treatment Medications Why Oral Antifungal Drug Interactions With Psych Meds Can Be Dangerous By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Marcia Purse Medically reviewed by Medically reviewed by Daniel B. Block, MD on September 25, 2020 twitter linkedin Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Review Board Daniel B. Block, MD Updated on December 16, 2020 Print Hero Images / Getty Images Have thrush? Athlete's foot? A vaginal infection? Jock itch? Before you treat yourself, you need to know whether any of the medications you are taking will interact with treatments for conditions like athlete's foot. Some antidepressants and antipsychotics, in particular, can react badly to antifungal medications. Overview Some antifungal drugs are designed to be taken orally -- for example, to treat yeast infections in the mouth and throat, such as thrush. The risk of drug interaction is higher with oral drugs than the topical applications sold over the counter. Athlete's foot is caused by a fungus, as are vaginal infections and jock itch. The common treatments for these conditions, called antifungals, usually come in creams, sprays, and powders. There are dozens of over-the-counter medications for fungus, the best known including Lotrimin, Monistat, Lamisil, Tinactin, and Desenex. Lesser-known brands abound, and major drugstore chains often have their own generic versions. The availability of antifungal medications makes it seem like they must be perfectly safe to use, and in fact, if you look up, for example, "Lotrimin warnings," you find that it says "no food and drug interactions have been reported." Yet if you look deeper, you'll find that there are known drug interactions and lots of them. Active Ingredients The most common active ingredients in antifungal medications are: ClotrimazoleMiconazoleTerbinafineTolnaftate Some fungus treatments have other active ingredients such as ketoconazole and butenafine. Only tolnaftate and butenafine are not expected to interact with other medications. Clotrimazole, miconazole, terbinafine, and ketoconazole list moderate to severe drug interactions, including with psychiatric medications. Interactions With Psychiatric Medications All the "azoles" can interact with certain psychiatric medications when used regularly. For example: Azoles used with Seroquel (quetiapine) can increase the plasma level to the point where the person using both may experience excessive drowsiness, fast or irregular heartbeat, dizziness, fainting, or extrapyramidal side effects.Azoles used with calcium channel blockers may cause such symptoms as swelling of the lower extremities, sudden, unexplained weight gain, difficulty breathing, chest pain or tightness, and dizziness or fainting.Ketoconazole used daily for 14 days increased the plasma concentration of Abilify (aripiprazole) about 70%.The product labels for Xanax (alprazolam) and Halcion (triazolam) both recommend against the use of any azole antifungal agent. Valium's label specifically mentions ketoconazole.These drugs may cause a significant increase in blood plasma levels of trazodone. This is just a sampling of the possible interactions of azole fungus treatments for conditions like athlete's foot with psychiatric drugs. In addition, the active ingredient terbinafine can increase plasma levels of several antidepressants, particularly the tricyclics. Nortriptyline intoxication has been noted after steady use of terbinafine antifungals. The only medication for oral thrush considered safe is nystatin, which is swished in the mouth, then swallowed. It is not absorbed into the bloodstream. The Bottom Line Ask the pharmacist about possible interactions and/or check with your doctor. They may recommend that you use a treatment containing butenafine and tolnaftate, and/or it may be necessary to adjust the dosage of one or more medications you are currently taking during the time you need to use the antifungal treatment. If you are prescribed an oral antifungal drug, make sure your doctor knows about all your existing medications. Whether you develop athlete's foot or some other fungus infection, don't reach blindly for an over-the-counter treatment if you take any medications, not just psychiatric drugs. What Are Psychoactive Drugs? Was this page helpful? Thanks for your feedback! Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Roussos P, Lewis RE, Kontoyiannis DP. Azoles and antidepressants: a mini-review of the tolerability of co-administration. Mycoses. 2009;52(5):433–439. doi:10.1111/j.1439-0507.2008.01677.x Kumar L, Verma S, Bhardwaj A, Vaidya S, Vaidya B. Eradication of superficial fungal infections by conventional and novel approaches: a comprehensive review. Artif Cells Nanomed Biotechnol. 2014;42(1):32–46. doi:10.3109/21691401.2013.769446 U.S. Food & Drug Administration. Highlights of prescribing information. Norvasc (amlodipine bsylate). Updated May 2011. U.S. Food & Drug Administration. Xanax alprazolam tablets, USP. Updated September 2016. U.S. Food & Drug Administration. Valium brand of diazepam tablets. Updated 2016. U.S. Food & Drug Administration. Highlights of prescribing information. Oleptro (trazodone hydrochloride). Updated January 2010. Van Der Kuy PH, Van Den Heuvel HA, Kempen RW, Vanmolkot LM. Pharmacokinetic interaction between nortriptyline and terbinafine. Ann Pharmacother. 2002;36(11):1712–1714. doi:10.1345/aph.1C083 Additional Reading Drug Interaction Checker. Drugs.com. Drug interactions between Calan and Clotrimazole. Drugs.com. Drug interactions between miconazole and Xanax. Drugs.com.