Interactions Between Oral Antifungal Medication And Psych Meds

Female doctor prescribing and explaining prescription medication to patient in clinic examination room

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Antifungal medications are used to treat a number of health issues, including thrush, athlete's foot, vaginal infection, and jock itch. Before taking one of these medicines, it's important to know about potential interactions with psychiatric medications as some interactions can be life-threatening.

Learn why antifungal medications are used and the types of medications that may be prescribed. We also discuss some of the ways that antifungal oral medication might interact with medications taken for psychiatric reasons, and how to take these medicines safely.

The Most Important Things to Know About Antifungal Oral Medications

  • Antifungal oral medications can change the way you absorb and metabolize other drugs.
  • The potential for drug interaction is higher with oral antifungal medications when compared to topical treatments.
  • Interactions with antifungal oral medications can be serious, sometimes even deadly.

Overview of Antifungal Oral Medications

Antifungal medicines are used to kill fungi or keep them from growing. This aids in the treatment of fungal infections, which can affect not only the skin and nails but also the circulatory and respiratory systems.

Antifungal medications come in several different forms. Some are available as a cream, spray, or powder and are generally used to treat conditions such as athlete's foot, vaginal infections, and jock itch. Other antifungal drugs are designed to be taken orally, including those used to treat yeast infections in the mouth and throat, such as thrush (oral candidiasis).

In addition to prescription options, there are dozens of over-the-counter medications for fungal infections. Some of the best-known include Lotrimin, Monistat, Lamisil, Tinactin, and Desenex. Lesser-known brands also exist, and major drugstore chains often have their generic versions.

The wide availability of antifungals can make it seem like they are perfectly safe to use. Yet, if you look a little deeper, you'll find that there ​are many known drug interactions with these types of medicines. The type of interaction can vary depending on the active ingredient contained in the antifungal oral medication.

Oral Antifungal Medication Options

Different active ingredients work in different ways. Some help treat infections by stopping the fungus from growing. Others kill the fungus by damaging the fungus wall or destroying the fungus cell.

Some of the most common active ingredients in antifungal medications include:

  • Clotrimazole
  • Miconazole
  • Terbinafine
  • Tolnaftate

Fungus treatments can also contain other active ingredients, such as ketoconazole and butenafine.

Common Prescription Antifungal Medications

Antifungal medications are prescribed under a variety of brand names. Prescription antifungal options include:

  • Canesten (clotrimazole)
  • Diflucan (fluconazole)
  • Daktarin (ketoconazole)
  • Lamisil (terbinafine)
  • Oravig (miconazole)
  • Nystan (nystatin)

In addition to oral antifungal medications, antifungals can also be administered topically or intravenously. How they are used often depends on the type of infection and its severity.

Antifungals That Interact With Psychiatric Medications

The risk of drug interaction with oral antifungal medications is higher than that of topical applications sold over the counter. The interaction risk can vary depending on the drug's active ingredient.

For example, the active ingredient terbinafine can have moderate to severe drug interactions with psychiatric medications. Specifically, it can increase plasma levels of several antidepressants, including trazadone and tricyclic antidepressants such as nortriptyline, resulting in these drugs exceeding toxic levels in the blood.

Interactions can also occur with all the "azole" antifungals or antifungal medications with active ingredients that end with -azole. This includes itraconazole, ketoconazole, and fluconazole, among several others. For example, in research studies, these medications have been found to interact with atypical antipsychotics such as:

  • Lurasidone, which is found in Latuda
  • Quetiapine, which is found in Seroquel
  • Risperidone, which is found in Risperdal
  • Ziprasidone, which is found in Geodon

This is just a sampling of the possible interactions of antifungal oral medications with psychiatric drugs. And not all antifungals have a risk of interaction. Nystatin, which is used to treat fungal infections in the stomach, is one drug with no expected interactions.

Medications That Should Not Be Used With Antifungals

The product labels for some psychiatric medications recommend against the use of any azole antifungal agents. This includes:

  1. Xanax (alprazolam)
  2. Halcion (triazolam)
  3. Valium (diazepam), which specifically mentions ketoconazole

Signs of an Antifungal-Psychiatric Medication Interaction

Symptoms that may be experienced when an antifungal medication interacts with a psychiatric medication can include:

  • Cardiac arrhythmia
  • Low blood pressure (hypotension)
  • Metabolic changes (such as weight gain and high blood sugar or cholesterol levels)
  • Swelling of the extremities (edema)

If you experience a bothersome side effect when taking both an antifungal oral medication and a psychiatric medicine, contact your healthcare provider. If the side effect is severe, seek immediate medical attention or call 911.

Using Antifungal Oral Medication Safely

If you are taking psychiatric medications, speak with your healthcare provider or a pharmacist about possible interactions. These healthcare professionals may recommend that you use an antifungal medication with a specific active ingredient and/or that the dosage of medications you are currently taking be adjusted during the time you use the antifungal treatment.

Additionally, if you are prescribed an oral antifungal drug, make sure your physician knows about all your existing medications. Interactions can occur with a variety of drugs, making it important that they know about everything you take to help reduce this risk.

Whether you develop athlete's foot or some other fungal infection, reaching blindly for an over-the-counter treatment if you take any medications (not just psychiatric drugs) can result in negative and sometimes serious consequences.

Frequently Asked Questions

  • Can athlete’s foot be treated with antifungal medication?

    Terbinafine (Lamasil) and clotrimazole (Lotrimin AF) can effectively treat athlete's foot. The most effective antifungal type may vary depending on the individual and the severity of the problem. If severe, talk to your healthcare provider about a prescription antifungal.

  • How does antifungal medication work in the body?

    How antifungals work depends on the type of medication. Azoles stop the fungus from growing, echinocandins damage the fungus walls, and polyenes kill and destroy the fungus cells.

  • Why does oral antifungal medication react badly with psychiatric drugs?

    In some cases, antifungals interfere with the actions of psychiatric medications. In other cases, they affect how psychiatric medications are metabolized, which can impact how long it takes a substance to clear from the body. If a person takes more medication before their last dose has metabolized, it may increase the risk of overdose.

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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.
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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.