Systemic candidiasis

January 2005     View PDF     En español

Side effects

Topical treatments
Topical creams and ointments may cause mild burning. Some people are highly sensitive and may have a widespread skin reaction with blisters and peeling. Some creams also contain a steroid to reduce inflammation that may cause itching, irritation or dryness. Vaginal tablets do not often cause problems, but in a few women they may lead to vaginal burning or itching or skin rash. Some women experience cramps or headaches.

Clotrimazole lozenges may cause minor changes in liver function, but this may not require stopping the drug. Oral irritation and nausea are rare side effects of nystatin lozenges. Nystatin oral rinse (Mycostatin) is nearly non-toxic, but it may cause gut problems if excessive doses are taken.

Systemic treatments
Side effects for the oral azole drugs are similar, but some studies show they’re more common with itraconazole. The most common are nausea, vomiting and belly pain. Others include headaches, dizziness, drowsiness, fever, diarrhea, rash and changes in taste. The most serious problem is liver toxicity, but this is rare and usually reverses after the drug is stopped. Nevertheless, liver function should be checked closely, particularly with ketoconazole.

Amphotericin B has many side effects, some quite severe. Therefore, it is only used in cases when there’s a direct threat to life or all other treatments have failed. Main side effects include kidney side effects and low red blood cells (anemia). Others include fever, chills, changes in blood pressure, changes in appetite, nausea, vomiting and headache. These reactions occur 1–3 hours after an infusion, are most severe with the first few doses, and diminish with later treatments. Side effects are generally the same with all amphotericin drugs, though ABCD and ABLC may be slightly less toxic.