Oral Antifungal Drug Interactions With Psych Meds

Oral Antifungal Drug Interactions With Psych Meds Bipolar Disorder Treatment Medications Print Why Oral Antifungal Drug Interactions With Psych Meds Can Be Dangerous 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. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on August 07, 2019 Hero Images / Getty Images More in Bipolar Disorder Treatment Medications Symptoms Diagnosis Have thrush? Athletes foot? A vaginal infection? 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 athletes foot. Some antidepressants and antipsychotics, in particular, can react badly to antifungal medications 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 drugs than the topical applications sold over the counter. Athletes 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 own generic versions. The availability of antifungal medications makes it seem like they must be perfectly safe to use, and in fact, if you look up, for example, Lotrimin warnings, you find that it says no food and drug interactions have been reported. Yet if you look deeper, youll find that there ?are known drug interactions and  lots of them. Active Ingredients in Antifungal Medications The most common active ingredients in antifungal medications are: ClotrimazoleMiconazoleTerbinafineTolnaftate 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. Clotrimazole, Miconazole, and Ketoconazole Interactions With Psychiatric Medications All the azoles can interact with certain psychiatric medications when used regularly. For example: These drugs may cause a significant increase in blood plasma levels of trazodone.Ketoconazole used daily for 14 days increased the plasma concentration of Abilify (aripiprazole) about 70%.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.The product labels for Xanax (alprazolam) and Halcion (triazolam) both recommend against the use of any azole antifungal agent. Valiums label specifically mentions ketoconazole. This is just a sampling of the possible interactions of azole fungus treatments for conditions like athletes 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. The Bottom Line on Antifungal Drug Interactions Whether you develop athletes foot or some other fungus infection, dont reach blindly for an over-the-counter treatment if you take any medications,  not just psychiatric drugs. 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. How to Avoid Harmful Medication Interactions