Antifungal Drugs for Aspergillosis

Last reviewed: 9 October 2026

Overview

Antifungal medicines are used to treat infections caused by fungi such as Aspergillus. These drugs work by damaging fungal cells or interfering with their growth.

Antifungal treatment is particularly important for chronic pulmonary aspergillosis (CPA) and invasive aspergillosis. In allergic bronchopulmonary aspergillosis (ABPA), antifungal medicines may be used alongside or instead of other treatments in selected circumstances.

Most established antifungal treatments for aspergillosis fall into three main groups:

• Polyenes
• Echinocandins
• Triazole antifungals (azoles)

The choice of drug depends on factors such as:

• the type and severity of aspergillosis
• the patient’s immune status
• previous treatments and treatment response
• potential drug interactions
• antifungal resistance
• other medical conditions, including liver or kidney disease

Some antifungal medicines are taken orally, while others must be given intravenously in hospital or through a supervised outpatient service.

For a broader overview of treatment options, see our Antifungals Hub.

Polyenes

Amphotericin B is one of the oldest and most powerful antifungal drugs. It is usually given intravenously for serious fungal infections.

This drug works by binding to a molecule in the fungal cell membrane called ergosterol. This disrupts the membrane, allowing essential cell contents to escape.

Amphotericin B has activity against a wide range of fungi, including:

• Aspergillus
• Candida
• Cryptococcus
• Histoplasma
• many species of Mucorales

Because conventional amphotericin B can cause significant side effects, particularly kidney toxicity, lipid formulations are often preferred. These include:

• liposomal amphotericin B
• amphotericin B lipid complex

Liposomal amphotericin B is commonly used when an intravenous alternative to azole treatment is required.

Amphotericin B may also be administered by nebuliser in selected situations to deliver medication directly to the airways. This is a specialist approach and is not a routine replacement for systemic treatment.

Echinocandins

Echinocandins are a group of antifungal drugs that interfere with the fungal cell wall.

They inhibit the production of β-1,3-glucan, an important structural component of fungal cell walls.

Examples include:

• caspofungin
• micafungin
• anidulafungin

These medicines are given intravenously because they are poorly absorbed from the digestive system.

Echinocandins are particularly effective against many Candida infections. They also have activity against Aspergillus, but their effects differ from those of azoles and amphotericin B.

Against Aspergillus, echinocandins primarily damage growing fungal hyphae rather than reliably eliminating the infection.

Echinocandins are not normally recommended as first-line treatment on their own for invasive aspergillosis. They may be considered as salvage treatment or in combination with another antifungal in selected patients under specialist supervision.

Triazole antifungals

The triazoles are among the most commonly used antifungal drugs for treating aspergillosis.

These medicines block an enzyme involved in the production of ergosterol, an essential component of fungal cell membranes.

Triazoles used against Aspergillus include:

• Itraconazole
• Voriconazole
• Posaconazole
• Isavuconazole

Each drug has a different clinical role:

• Itraconazole – commonly used for chronic pulmonary aspergillosis and allergic fungal disease.
• Voriconazole – an important first-line treatment option for invasive aspergillosis and also used for chronic pulmonary aspergillosis.
• Posaconazole – a broad-spectrum antifungal used for selected treatment indications and prevention of fungal infections in high-risk patients.
• Isavuconazole – an alternative first-line option for invasive aspergillosis, with activity against certain fungi belonging to the Mucorales group.

Fluconazole is not effective against Aspergillus and is not used to treat aspergillosis, although it is useful for certain other fungal infections.

For more detailed information about individual medicines, including practical advice for patients, visit the Antifungals Hub.

Antifungal resistance

Some strains of Aspergillus, particularly Aspergillus fumigatus, have developed resistance to azole antifungal medicines.

Resistance can develop during prolonged treatment or arise through exposure to azole fungicides in the environment.

A resistant infection may respond poorly to an antifungal medicine that would normally be effective.

Where possible, specialist laboratories may perform fungal culture, susceptibility testing or molecular resistance testing to help guide treatment.

Resistance does not necessarily mean that all antifungal treatments will fail. Alternative drugs or combinations may still be effective.

Drug absorption

Some antifungal medications taken by mouth can be difficult for the body to absorb.

For example, conventional itraconazole capsules depend on stomach acidity for adequate absorption. Medicines that reduce stomach acid, including proton pump inhibitors, can therefore reduce the amount absorbed.

Depending on the formulation, patients may be advised to:

• take conventional itraconazole capsules with food
• avoid or carefully manage medicines that reduce stomach acidity
• follow specific instructions about timing and formulation

Itraconazole oral solution is generally taken on an empty stomach because it is absorbed differently.

Other itraconazole formulations may have different instructions, so advice for one formulation should not automatically be applied to another.

Because absorption varies between individuals, doctors often use therapeutic drug monitoring (TDM) to check antifungal concentrations in the blood.

TDM helps specialists determine whether a patient is receiving enough medication while avoiding unnecessarily high levels that may increase side effects.

Read more about antifungal dosing, monitoring and specialist care.

Side effects and interactions

All medications can cause side effects. Many patients tolerate antifungal treatment reasonably well, but adverse effects can become important, particularly during prolonged courses.

Possible side effects include:

• nausea, diarrhoea or stomach upset
• liver function abnormalities
• skin sensitivity to sunlight, particularly with voriconazole
• temporary visual disturbances with voriconazole
• changes in blood pressure, electrolyte levels or kidney function with certain antifungals

Azole antifungals can interact with many other medications because they affect enzymes involved in drug metabolism.

Important interactions can occur with corticosteroids, anticoagulants, some cholesterol-lowering medicines and other commonly prescribed drugs.

Some combinations may increase drug concentrations and cause serious adverse effects.

Patients should ensure that their specialist, GP and pharmacist know about all prescription medicines, over-the-counter products and supplements they take.

Read our guide to antifungal drug interactions.

Healthcare professionals can check interactions using the British National Formulary (BNF).

Do not stop or change prescribed antifungal treatment without discussing it with your healthcare team. If serious side effects occur, seek prompt medical advice.

Reporting side effects

Suspected side effects should be discussed with the prescribing team. They can also be reported to national medicines safety systems.

United Kingdom

Side effects can be reported through the MHRA Yellow Card Scheme. Patients can submit reports directly without needing to go through a doctor.

United States

Side effects can be reported through the FDA MedWatch programme.

Antifungal availability

Access to antifungal medicines varies considerably around the world. In some countries, essential antifungal drugs may be difficult to obtain or prohibitively expensive.

The Global Action Fund for Fungal Infections (GAFFI) has produced resources showing global antifungal availability.

View the GAFFI antifungal availability maps.

Further information

Detailed information about individual antifungal medicines can be found in the Patient Information Leaflet (PIL) supplied with each medication.

Patients with aspergillosis may also require corticosteroids, biologic therapies or other treatments depending on the type and severity of their disease.

For further reading:

• Antifungals Hub – individual medicines and treatment information
• Antifungal dosing, monitoring and specialist care
• Understanding antifungal drug interactions
• New antifungal treatments in development

Always read the medication leaflet carefully and discuss any concerns with your doctor or pharmacist.

Author and review information