Azoles for treating thrush

Examples

Brand Name	Generic Name	Chemical Name
Mycelex	clotrimazole
Diflucan	fluconazole
Sporanox	itraconazole
Noxafil	posaconazole
VFEND	voriconazole

These medicines are available as:

• A mouth rinse that is put directly on the infected area (topical).
• A lozenge that dissolves in the mouth.
• A tablet that is swallowed (oral).

How It Works

Azoles stop the growth of the yeast that causes thrush. This gives the body's immune system a better chance to destroy the yeast.

Why It Is Used

These medicines may be used for cases of thrush that have not responded to nystatin (a polyene).¹

• Clotrimazole lozenges or fluconazole pills may be used to treat thrush in older children and adults.
• Fluconazole and itraconazole may be used to treat thrush that has spread into the esophagus. Voriconazole or posaconazole are other medicines to treat more severe cases of thrush.

How Well It Works

Azoles are effective in curing thrush, especially when other topical treatment has not been helpful.²

Fluconazole, posaconazole, and voriconazole can cure thrush that has spread into the esophagus.

Side Effects

Although azoles rarely cause side effects, they may cause:

• Nausea, vomiting, and belly pain.
• Headache.
• Itching, skin rash.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

An azole or nystatin is usually the first medicine used to treat thrush in children.³

It is hard for some people to use a nystatin mouthwash because of its taste. In these cases, clotrimazole lozenges may be given instead.¹ But there is a slight possibility that taking clotrimazole can cause liver problems. Because of this, it is rarely given to children.

Certain medicines can interact with azoles. This can make the azole less effective or can cause problems with the liver. Some of these medicines include:

• Some ulcer medicines (sucralfate and acid reducers).
• A seizure medicine called phenytoin (Dilantin).
• A tuberculosis medicine (rifampin).
• A medicine used to prevent rejection in organ transplants (cyclosporine).
• A blood thinner called warfarin (Coumadin).

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References

Citations

1. Dominguez SR, et al. (2009). Candidiasis section of Infections: Parasitic and mycotic. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 1212–1215. New York: McGraw-Hill Medical.

2. Fox CR, Sande MA (2001). Candida species. In WR Wilson et al., eds., Current Diagnosis and Treatment in Infectious Diseases, pp. 734–744. New York: McGraw-Hill.

3. Knapp KM, Flynn PM (2009). Candidiasis. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2741–2751. Philadelphia: Saunders Elsevier.

By:	Healthwise Staff	Last Revised: April 15, 2010
Medical Review:	Susan C. Kim, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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