🩺 Article 1: Managing Side Effects of Aspergillosis Treatments

Subtitle: What to expect, how to recognise problems early, and when to ask for help.

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💊 Why This Matters

People living with aspergillosis, bronchiectasis, or Primary Ciliary Dyskinesia (PCD) often take several medicines for months or even years.
These drugs are vital for controlling infection, inflammation, and allergic reactions — but they can also cause side effects or drug interactions.

Being aware of what’s normal, what’s not, and when to seek help helps you stay safe while getting the most from treatment.

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⚗️ Antifungal Medicines

Antifungal (azole) drugs are the backbone of treatment for Chronic Pulmonary Aspergillosis (CPA) and Allergic Bronchopulmonary Aspergillosis (ABPA).
They control infection but can affect the liver, heart, or skin, so regular blood monitoring is essential.

Itraconazole (Sporanox® / generic)

Used for long-term control in CPA and ABPA.

• Common: tiredness, nausea, ankle swelling, blurred vision.

• Serious: yellowing skin/eyes, dark urine, shortness of breath.

• Tips:

  • Take with a main meal or fizzy drink (acidic stomach aids absorption).

  • Avoid taking it with omeprazole or similar acid-reducing drugs, as these block absorption.

  • Have regular liver-function and drug-level blood tests.

  • Report ankle swelling or jaundice immediately.

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Voriconazole (Vfend®)

Used when itraconazole isn’t effective or tolerated.

• Common: temporary visual flashes or blurred vision, sunlight sensitivity, mild headache.

• Serious: severe rash, blistering, or long-term skin-cancer risk from sunlight.

• Tips:

  • Always use SPF 30+ sun cream, even in winter.

  • Avoid prolonged sun exposure.

  • Report any visual change, rash, or fatigue promptly.

  • Blood monitoring checks for safe drug levels.

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Posaconazole (Noxafil®)

Used for resistant infections or as a second-line therapy.

• Common: nausea, diarrhoea, fatigue.

• Serious: liver inflammation, low potassium (causing muscle cramps or irregular heartbeat).

• Tips:

  • Take with a main meal or full-fat snack.

  • Report unexplained muscle weakness or palpitations.

  • Keep up with blood tests.

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Isavuconazole (Cresemba®)

A newer antifungal option that may cause fewer interactions.

• Common: headache, mild nausea, ankle swelling.

• Tips:

  • Continue regular liver and kidney checks.

  • Report any new swelling, fatigue, or breathlessness.

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💨 Corticosteroids

(Prednisolone, Methylprednisolone, Hydrocortisone)
These reduce inflammation and allergic response in ABPA and asthma.
They are powerful — but long-term use can affect weight, mood, bones, and hormone balance.

• Common: increased appetite, fluid retention, mood swings, difficulty sleeping.

• Long-term: thinning bones, higher blood sugar, adrenal suppression.

• Tips:

  • Never stop suddenly — always taper under medical advice.

  • Carry a Steroid Emergency Card.

  • Ask about bone protection (vitamin D, calcium, bisphosphonates).

  • See your GP if you feel very tired, dizzy, or unwell.

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🧬 Biologic Treatments

(Mepolizumab, Benralizumab, Omalizumab)
These injection-based medicines target inflammation or allergic responses in severe asthma or ABPA.

• Common: mild injection-site soreness, tiredness, headache.

• Occasional: mild fever or muscle aches.

• Serious: allergic swelling of lips, tongue, or throat.

• Tips:

  • Record any mild reactions.

  • If you develop swelling or difficulty breathing, call 999 immediately.

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💊 Long-Term Antibiotics

(Azithromycin, inhaled colomycin, tobramycin)
Used to reduce bacterial infections in bronchiectasis or PCD.

• Common: stomach upset, diarrhoea, mild throat irritation.

• Long-term: tinnitus or hearing loss (especially with azithromycin).

• Tips:

  • Have periodic hearing checks.

  • Rinse mouth and nebuliser after inhaled antibiotics.

  • Report ringing in the ears, severe diarrhoea, or rash.

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⚠️ Drug Interactions

Antifungal medicines (especially azoles) can interfere with many common drugs, including:

• Steroids (e.g., prednisolone, fluticasone) — may increase steroid levels.

• Reflux medicines (e.g., omeprazole, lansoprazole) — reduce antifungal absorption.

• Statins and warfarin — increase risk of side effects or bleeding.

• Some antihistamines and antibiotics — can affect heart rhythm.

These interactions can be complex — always check before starting or stopping any medication.

✅ Check it yourself:
You can use the official BNF Interactions Checker (NICE Medicines Guidance) to see if two medicines are known to interact.
Simply type the names (e.g., itraconazole and prednisolone) and it will show the risk level, what the interaction does, and what clinicians usually recommend.
If unsure, show the result to your GP, pharmacist, or hospital team — they can interpret it for your situation.

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🚨 When to Seek Help

Call your specialist or GP urgently if you notice:

• Yellowing of skin or eyes

• Severe rash, blistering, or peeling

• New ankle swelling or breathlessness

• Sudden fatigue or dark urine

• Visual changes or increased photosensitivity

• Ringing in the ears or hearing loss

If you feel acutely unwell, do not stop your medication abruptly — contact your hospital team or emergency services.

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🔗 Next read: Why Awareness Matters – Staying Safe and Confident on Aspergillosis Treatment »