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 different health issues, including thrush, athlete's foot, vaginal infection, and 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.

This article discusses why antifungal medications are used, types of medications that may be prescribed, and some of the ways they might interact with psychiatric medications.

Overview of Antifungal Medication

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 antifungal 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 generic versions.

The availability of antifungal medications makes it seem like they must be perfectly safe to use. In fact, if you look up "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 in Antifungal Medication

The most common active ingredients in antifungal medications are:

  • Clotrimazole
  • Miconazole
  • Terbinafine
  • Tolnaftate

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.

Common Antifungal Pills

Antifungal medications are prescribed under a variety of brand names. Some of the most commonly prescribed pills are:

  • 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.

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.

A Word From Verywell

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.

Frequently Asked Questions

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

    Lamasil (terbinafine) can be highly effective in treating athlete's foot. Another type of antifungal medication that may help is Lotrimin AF (clotrimazole). The most effective antifungal type may vary depending on the individual and the severity of the problem. If severe, you should talk to your healthcare provider about a prescription antifungal.

  • How does antifungal medication work in the body?

    Antifungal medications work by either killing the fungus directly or by preventing it from growing. How they 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?

    These interactions can occur for a number of reasons. In some cases, antifungals interfere with the actions of psychiatric medications. In other cases, they produce unwanted side effects such as drowsiness, dizziness, and rapid heartbeat. They can also 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.

9 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.
  1. Roussos P, Lewis RE, Kontoyiannis DP. Azoles and antidepressants: a mini-review of the tolerability of co-administrationMycoses. 2009;52(5):433–439. doi:10.1111/j.1439-0507.2008.01677.x

  2. Kumar L, Verma S, Bhardwaj A, Vaidya S, Vaidya B. Eradication of superficial fungal infections by conventional and novel approaches: a comprehensive reviewArtif Cells Nanomed Biotechnol. 2014;42(1):32–46. doi:10.3109/21691401.2013.769446

  3. U.S. Food & Drug Administration. Highlights of prescribing information. Norvasc (amlodipine bsylate).

  4. U.S. Food & Drug Administration. Xanax alprazolam tablets, USP.

  5. U.S. Food & Drug Administration. Valium brand of diazepam tablets.

  6. U.S. Food & Drug Administration. Highlights of prescribing information. Oleptro (trazodone hydrochloride).

  7. Van Der Kuy PH, Van Den Heuvel HA, Kempen RW, Vanmolkot LM. Pharmacokinetic interaction between nortriptyline and terbinafineAnn Pharmacother. 2002;36(11):1712–1714. doi:10.1345/aph.1C083

  8. Cleveland Clinic. Athlete's foot (tinea pedis)

  9. Cleveland Clinic. Antifungals.

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.