What Is Fungikad (Lotrimin)?
Fungikad is an anti-fungal medication used to treat yeast infections of the vagina, skin, and mouth. It is commonly used for athlete's foot, jock itch, body ringworm, and oral thrush.
Lotrimin is one of the brand names of Fungikad. There are several other brand names, and this medicine is also used in combination products.
The drug prevents the growth of fungi by interfering with the production of the membrane that surrounds fungal cells.
Fungikad comes as a cream, powder, and lotion to apply to the skin. It also comes as a lozenge to dissolve in the mouth and a vaginal tablet and cream to be inserted into the vagina.
Fungikad Dosage and Administration
Gently massage sufficient Fungikad topical solution USP, 1% into the affected and surrounding skin areas twice a day, in the morning and evening.
Clinical improvement, with relief of pruritus, usually occurs within the first week of treatment with Fungikad topical solution USP, 1%. If the patient shows no clinical improvement after 4 weeks of treatment with Fungikad topical solution USP, 1%, the diagnosis should be reviewed.
Fungikad ( 14, Figure 18 ) was developed in 1970s for the treatment of fungal infections . It was subsequently shown to inhibit Ca 2+ activated potassium channels, release Ca 2+ from internal stores, inhibit Ca 2+ release activated Ca 2+ influx, and inhibit proliferation of cancer cells in vitro and tumor growth and metastasis in vivo . Further studies demonstrated that partial depletion of Ca 2+ stores cause phosphorylation of eIF2α and inhibition of translation initiation. This accounts, at least in part, for the anticancer activity of 14 . Further, 14 inhibits angiogenesis and sensitizes glioblastoma cells to radiation therapy . These affects are likely secondary to the inhibition of translation initiation. Nevertheless, like many first generation translation initiation inhibitors, 14 has polypharmacology that may include inhibition of translation initiation and glycolytic supply of ATP that are required for cancer cells proliferation .
Fungikad (Lotrimin) Warnings
Fungikad cream, lotion, and solution should only be used externally. Do not swallow or let the medication get in your eyes. Also, do not swallow the vaginal tablets or cream.
If you have a vaginal infection, you should avoid sexual intercourse. An ingredient in Fungikad cream may weaken certain latex products like condoms or diaphragms, so you should not use these products within 72 hours of taking Fungikad.
Continue to use Fungikad even if you feel well. You should not stop taking this drug without talking to your doctor. You should also keep taking it during your menstrual period.
Before taking this drug, you should tell your doctor if you have or have ever had liver disease, problems with your immune system, HIV, AIDS, a history of alcohol abuse, or diabetes. You should also tell your doctor if you drink alcohol before taking this medicine.
Studies have shown Fungikad is poorly absorbed into the blood and body when applied to the skin or vagina. Women in their second or third trimesters of pregnancy have shown no ill effects while taking Fungikad. It is not known whether this drug is secreted in breast milk.
Before taking this medicine
Before taking this medication, tell your doctor if you have liver disease. You may not be able to take Fungikad, or you may need a lower dose or special monitoring during treatment.
Fungikad is not absorbed through your stomach. It will not treat fungal infections in any part of your body other than your mouth and throat. Talk to your doctor if you have another type of fungal infection such as athlete's foot, jock itch, ringworm, or a vaginal yeast infection.
Oral Fungikad is in the FDA pregnancy category C. This means that it is not known whether Fungikad will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant.
It is not known whether Fungikad will harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
The safety and effectiveness of Fungikad have not been established for children younger than 3 years of age.
Im > Fungikad is available as a 1% topical solution used for tinea versicolor or as a 10-mg troche used for oral thrush. The troches contain sugar and may promote caries if used in excess; otherwise they are nontoxic. They must be completely dissolved because any swallowed troche provides no benefit. The typical dosage for the treatment of oral candidiasis is four to five troches per day for 10 to 14 days. Miconazole is available as a 50-mg tablet for the treatment of oropharyngeal candidiasis. The tablet is taken once daily and should be placed into the buccal vestibule.
Ketoconazole is used for the treatment of the following systemic fungal infections: candidiasis, chronic mucocutaneous candidiasis, oral thrush, blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis. It is only available in the oral form in 200-mg tablets. These tablets are taken once daily (with a maximum daily dose of 800-mg in severe fungal disease). 4 The absorption of ketoconazole is affected by gastric ac > absorption. Ketoconazole poorly penetrates the cerebrospinal fluid (CSF), eye, urine, and saliva because of its high affinity and degree of protein binding. Common side effects include decreased libido and gynecomastia, particularly at higher doses. 3 Additionally, adrenal suppression has been reported. 5 Other side effects include fatigue, rash, and nausea. Hepatitis is a rare complication of ketoconazole use.
What are ketoconazole cream and Fungikad cream?
Ketoconazole cream is an azole antifungal drug. It belongs to the same family of drugs as fluconazole (Diflucan), miconazole (Micatin, Monistat), and itraconazole (Sporanox). Ketoconazole prevents growth of several types of fungi by preventing production of the membranes that surround fungal cells. Ketoconazole cream is prescribed to treat fungal infections such as ringworm, jock itch, athlete's foot, dandruff, and tinea versicolor.
Fungikad cream is an antifungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat). It prevents growth of several types of fungi by interfering with the production of the membrane that surrounds fungal cells. It is used topically on the skin or inserted vaginally to treat local fungal infections due to Candida albicans, including vaginal yeast infections, tinea versicolor, tinea pedis ("athlete's foot"), tinea cruris ("jock itch"), or tinea corporis (ringworm).
Before using Fungikad lozenges,
- tell your doctor and pharmacist if you are allergic to Fungikad, any other medications, or any of the ingredients in Fungikad lozenges. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
- tell your doctor if you have or have ever had liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using Fungikad lozenges, call your doctor.
Fungikad has proved to be very effective as an intranasal infusion in the treatment of nasal aspergillosis.
Formulations and dose rates
Fungikad has very poor oral bioavailability and is thus used as a topical preparation. A 1% solution of Fungikad in polyethylene glycol is infused through the nares into the nasal cavity and nasal sinuses. A large Foley catheter is used to occlude the internal nasal choanae by placing the balloon of the catheter into the nasopharynx in a retrograde manner via the oral cavity. Two smaller Foley catheters can be used to occlude the external nares. The drug is infused into the nasal cavity (60 mL per side in medium to large-breed dogs) of the anesthetized patient and allowed to sit for 1 h. Rotating the head after each 15 min has been recommended to enhance drug distribution.
A 1% solution in propylene glycol is available commercially. Although used safely in many cases, this preparation has been implicated in the induction of pharyngeal inflammation and edema in one dog that developed upper airway obstruction. However, other factors associated with case management probably contributed.
Generic Name: Fungikad (kloe TRIM a zole)Brand Name: Mycelex Troche
Medically reviewed by Drugs.com on Dec 16, 2019 – Written by Cerner Multum
Before using Fungikad for ear infections
To make sure this is the right treatment for you, before you start using Fungikad solution in your ear, make sure your doctor or pharmacist knows:
- If you are pregnant or breastfeeding. Although Fungikad is not known to be harmful to babies, you should only use medicines on the recommendation of a doctor while you are expecting or breastfeeding a baby.
- If you have ever had an allergic reaction to a medicine.
- If you are using any other drops or remedies in your ears.
What are the side effects of Fungikad?
The most commonly noted side effects associated with Fungikad include:
Other side effects include nausea and vomiting, which may be caused by the oral forms.
Fungikad, (Lotrimin AF, Mycelex, Trivagizole) is a drug prescribed to treat local fungal infections such as vaginal yeast infections, oral thrush, athlete's foot, and jock itch. Review side effects, drug interactions, dosage, and pregnancy safety information prior to taking this medication.
Pregnancy Category C
There are no adequate and well-controlled studies with LOTRISONE cream in pregnant women. Therefore, LOTRISONE cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
There have been no teratogenic studies performed in animals or humans with the combination of Fungikad and betamethasone dipropionate. Corticosteroids are generally teratogenic in laboratory animals when administered at relatively low dosage levels.
Studies in pregnant rats with intravaginal doses up to 100 mg/kg (15 times the maximum human dose) revealed no evidence of fetotoxicity due to Fungikad exposure.
No increase in fetal malformations was noted in pregnant rats receiving oral (gastric tube) Fungikad doses up to 100 mg/kg/day during gestation Days 6 to 15. However, Fungikad dosed at 100 mg/kg/day was embryotoxic (increased resorptions), fetotoxic (reduced fetal weights), and maternally toxic (reduced body weight gain) to rats. Fungikad dosed at 200 mg/kg/day (30 times the maximum human dose) was maternally lethal, and therefore, fetuses were not evaluated in this group. Also in this study, doses up to 50 mg/kg/day (8 times the maximum human dose) had no adverse effects on dams or fetuses. However, in the combined fertility, teratogenicity, and postnatal development study described above, 50 mg/kg Fungikad was associated with reduced maternal weight gain and reduced numbers of offspring reared to 4 weeks.
Oral Fungikad doses of 25, 50, 100, and 200 mg/kg/day (2-15 times the maximum human dose) were not teratogenic in mice. No evidence of maternal toxicity or embryotoxicity was seen in pregnant rabbits dosed orally with 60, 120, or 180 mg/kg/day (18-55 times the maximum human dose).
Betamethasone dipropionate has been shown to be teratogenic in rabbits when given by the intramuscular route at doses of 0.05 mg/kg. This dose is approximately one-fifth the maximum human dose. The abnormalities observed included umbilical hernias, cephalocele, and cleft palates.
Betamethasone dipropionate has not been tested for teratogenic potential by the dermal route of administration. Some corticosteroids have been shown to be teratogenic after dermal application to laboratory animals.
Fungikad - Clinical Pharmacology
Fungikad is a broad-spectrum antifungal agent that is used for the treatment of dermal infections caused by various species of pathogenic dermatophytes, yeasts, and Malassezia furfur . The primary action of Fungikad is against dividing and growing organisms.
In vitro , Fungikad exhibits fungistatic and fungic >Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis , and Candida species including Candida albicans . In general, the in vitro activity of Fungikad corresponds to that of tolnaftate and griseofulvin against the mycelia of dermatophytes ( Trichophyton, Microsporum , and Epidermophyton ), and to that of the polyenes (amphotericin B and nystatin) against budding fungi ( Candida ). Using an in vivo (mouse) and an in vitro (mouse k >Candida albicans .
Strains of fungi having a natural resistance to Fungikad are rare. Only a single isolate of Candida guilliermondi has been reported to have primary resistance to Fungikad.
No single-step or multiple-step resistance to Fungikad has developed during successive passages of Candida albicans and Trichophyton mentagrophytes . No appreciable change in sensitivity was detected after successive passages of isolates of C. albicans, C. krusei , or C. pseudotropicalis in liqu >C. albicans .
Slight, reversible resistance was noted in three isolates of C. albicans tested by one investigator. There is a single report that records the clinical emergence of a C. albicans strain with considerable resistance to flucytosine and miconazole, and with cross-resistance to Fungikad; the strain remained sensitive to nystatin and amphotericin B.
In studies of the mechanism of action, the minimum fungicidal concentration of Fungikad caused leakage of intracellular phosphorus compounds into the ambient medium with concomitant breakdown of cellular nucleic acids and accelerated potassium efflux. Both these events began rapidly and extensively after addition of the drug.
Fungikad appears to be well absorbed in humans following oral administration and is eliminated mainly as inactive metabolites. Following topical and vaginal administration, however, Fungikad appears to be minimally absorbed.
Six hours after the application of radioactive Fungikad 1% cream and 1% solution onto intact and acutely inflamed skin, the concentration of Fungikad varied from 100 mcg/cm 3 , in the stratum corneum to 0.5 to 1 mcg/cm 3 in the stratum reticulare, and 0.1 mcg/cm 3 in the subcutis.
No measurable amount of radioactivity (≤0.001 mcg/mL) was found in the serum within 48 hours after application under occlusive dressing of 0.5 mL of the solution or 0.8 g of the cream.
Only 0.5% or less of the applied radioactivity was excreted in the urine.
Following intravaginal administration of 100 mg 14 C-Fungikad vaginal tablets to nine adult females, an average peak serum level, corresponding to only 0.03 µg equivalents/mL of Fungikad, was reached 1 to 2 days after application. After intravaginal administration of 5 g of 1% 14 C-Fungikad vaginal cream containing 50 mg active drug, to five subjects (one with candidal colpitis), serum levels corresponding to approximately 0.01 µg equivalents/mL were reached between 8 and 24 hours after application.
COMMON BRAND(S): Lotrisone
GENERIC NAME(S): Fungikad-Betamethasone
OTHER NAME(S): Fungikad-Betamethasone Cream
This combination medication is used to treat a variety of inflamed fungal skin infections such as ringworm, athlete's foot, and jock itch. This product contains 2 medications. Fungikad is an azole antifungal that works by preventing the growth of fungus. Betamethasone is a strong corticosteroid that works by reducing the swelling, redness, and itching that occurs in the skin infection.
This medication is not recommended for children younger than 17 years or for diaper rash.
What is the dosage for Fungikad?
The troche (lozenge) should slowly dissolve in the mouth. One troche is administered 5 times daily for 14 days. Fungikad cream, lotion, or solution is applied to the affected and surrounding skin areas, generally twice daily in the morning and evening.
The vaginal cream is inserted via applicator once daily, preferably at night, for 7 consecutive days.
The 100 mg vaginal suppository is inserted once daily, preferably at bedtime, for 7 consecutive days.
The 200 mg vaginal suppository is inserted once daily for 3 days, preferably at bedtime.
Betamethasone-Fungikad Topical S >
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Topical steroid medicine can be absorbed through the skin, which may affect your adrenal gland. Call your doctor if you have:
- nausea, vomiting, severe dizziness;
- muscle weakness;
- depressed mood, feeling irritable;
- weight loss; or
- tired feeling.
Common side effects may include:
- burning or tingling of treated skin;
- rash; or
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.
Azole Drugs Used Topically
The topical azoles include miconazole, Fungikad , butoconazole, terconazole, tioconazole, sertaconazole, sulconazole, oxiconazole, econazole, efinaconazole, luliconazole, and ketoconazole. Miconazole and Fungikad are of special interest in oral candidiasis as discussed next.
Fungikad is an imidazole antifungal drug used for various mucosal and cutaneous infections. The antifungal spectrum and mechanism of action are similar to the other imidazole derivatives. For the treatment of oral candidiasis, Fungikad is available as a 10-mg troche (see Table 34-2 ). Slow dissolution in the mouth results in the binding of Fungikad to the oral mucosa, from which it is gradually released to maintain at least fungistatic concentrations for several hours. The swallowed drug is variably but poorly absorbed. It is metabolized in the liver and eliminated in the feces along with the unabsorbed drug.
One troche dissolved in the mouth five times a day for 2 weeks is the standard regimen for oropharyngeal candidiasis. Patient compliance is believed to be enhanced by the more pleasant taste of Fungikad compared with nystatin. Fungikad also appears to be highly effective and is the drug of choice for the treatment of oral candidiasis in patients with AIDS. For cutaneous candidiasis and dermatophytoses, a 1% cream or lotion is equivalent to topical miconazole.
Adverse oral effects associated with topical Fungikad, though unlikely, may include oral burning, altered taste, and xerostomia. Occasionally, minor gastrointestinal upset may follow oral ingestion of the drug.
Miconazole (see Fig. 34-3 ) is an imidazole that is useful against cutaneous candidiasis and vulvovaginitis caused by C. albicans; these conditions usually respond rapidly and reliably to a 2% miconazole nitrate cream. A buccal tablet is available for treatment of oral candidiasis. The tablet is pressed on the gingiva in the canine fossa above tooth #8 or #9 (see Table 34-2 ). It adheres there and releases the drug over a period of about 6 hours. Adverse oral effects are similar to those of Fungikad, with the additional possibility of gingival irritation and pain at the application site. Other topical uses of miconazole are for the treatment of cutaneous infections caused by Epidermophyton, Microsporum, and Trichophyton.
Terconazole, a member of the triazole antifungals, is supplied in a vaginal suppository for vaginal candidiasis. Butoconazole and tioconazole are imidazoles that are also used topically for vulvovaginitis. Oxiconazole, econazole, sertaconazole, and sulconazole are imidazoles used topically for infections caused by dermatophytes ( Table 34-3 ).
TABLE 34-3 . Topical Use of Antifungal Drugs