Fungal Infections: Their Diagnosis and Treatment in Transplant Recipients

Table 4

Current contraindications and FDA warnings for each antifungal agent available.

Drug	Contraindications	Warnings
Amphotericin B deoxycholate	Hypersensitivity to amphotericin B	Anaphylaxis
Lipid formulations of AMB	Hypersensitivity to amphotericin B	Anaphylaxis
Fluconazole	Hypersensitivity to fluconazole	Hepatic injury, anaphylaxis, and dermatologic
Itraconazole	Terfenadine, astemizole, dofetilide, pimozide, quinidine, oral midazolam, triazolam, cisapride, and statins should also be discontinued during therapy	Black box for terfenadine and congestive Heart failure see contraindications
Posaconazole	Hypersensitivity to the active substance or excipients, ergot alkaloids, coadministration with 3A4 substrates (terfenadine, astemizole, cisapride, pimozide, halofantrine, and quinidine)	Hypersensitivity, hepatic toxicity, recommended monitoring of hepatic function (LFTs), cyclosporine, tacrolimus, and sirolimus
Voriconazole	Hypersensitivity to voriconazole, CYP3A4 inhibitors (terfenadine, astemizole, cisapride, pimozide, and quinidine), sirolimus, rifampin, carbamezapine, long acting barbiturates, ritonavir, efavirenz, rifabutin, and ergot alkaloids (ergotamine and dihydroergotamine)	Visual disturbances, hepatic toxicity, recommended monitoring of LFTs and bilirubin, pregnancy category D, and galactose intolerance
Anidulafungin	Hypersensitivity to anidulafungin or other echinocandins	None
Caspofungin	Hypersensitivity to caspofungin or other echinocandins	Elevated liver enzymes with cyclosporine
Micafungin	Hypersensitivity to micafungin or other echinocandins	Hypersensitivity, hematological effects (hemolysis, hemolytic anemia, and hemoglobinuria), hepatic effects (abnormal LFTs, hepatic dysfunction, hepatitis, and hepatic failure), and renal effects (elevations of BUN and creatinine, renal dysfunction, and acute renal failure)