Last reviewed: 11 March 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.

Most antifungal treatments fall into three main groups:

• Polyenes
• Echinocandins
• Triazole antifungals (azoles)

The choice of drug depends on factors such as:

• the type of aspergillosis
• the patient’s immune status
• previous treatments
• potential drug interactions

Some antifungal medicines are taken orally, while others must be given intravenously in hospital.

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. When amphotericin binds to ergosterol it creates pores in the fungal cell membrane, causing the cell to leak and die.

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

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

Because amphotericin can cause significant side effects, newer lipid formulations are often used. These include:

• liposomal amphotericin B
• amphotericin B lipid complex

Amphotericin may also be given by nebuliser in some situations to deliver medication directly to the lungs.

Echinocandins

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

They block the production of β-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 very effective against Candida infections and have activity against Aspergillus. However, they usually inhibit fungal growth rather than killing the fungus completely.

For this reason they are often used in combination therapy or when other treatments cannot be used.

Triazole antifungals

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

These medicines work by blocking enzymes involved in the production of ergosterol, a key component of the fungal cell membrane.

Common triazole antifungals include:

• Itraconazole
• Voriconazole
• Posaconazole
• Isavuconazole
• Fluconazole (less active against Aspergillus)

Each drug has a slightly different spectrum of activity:

• Itraconazole – commonly used for chronic pulmonary aspergillosis and allergic fungal disease.
• Voriconazole – often used as first-line treatment for invasive aspergillosis.
• Posaconazole – broad-spectrum antifungal used for treatment and prevention of fungal infections.
• Isavuconazole – a newer azole with activity against Aspergillus and some Mucorales.

Some fungi may develop resistance to azole antifungals, which is an increasing concern in clinical practice.

Drug absorption

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

For example, itraconazole capsules require stomach acid for proper absorption. This means medications that reduce stomach acid (such as antacids or proton pump inhibitors) may reduce their effectiveness.

Patients are often advised to:

• take itraconazole capsules with food
• avoid antacid medication close to dosing
• sometimes take the medicine with an acidic drink

In contrast, itraconazole liquid formulation is usually taken on an empty stomach because it is absorbed differently.

Because absorption varies between individuals, doctors may perform therapeutic drug monitoring using blood tests to ensure that the drug levels are adequate.

Side effects and interactions

All medications can cause side effects. Most antifungal drugs are generally well tolerated, but some side effects can occur.

Possible side effects include:

• nausea or stomach upset
• liver function abnormalities
• skin sensitivity to sunlight
• visual disturbances (with voriconazole)

Azole antifungals can interact with many other medications because they affect liver enzymes responsible for drug metabolism.

It is important to check for possible drug interactions before starting antifungal treatment. In the UK, this can be done using the British National Formulary (BNF).

Patients should always consult their doctor before stopping any medication.

Reporting side effects

United Kingdom

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

United States

Side effects can be reported directly to the FDA MedWatch programme.

Antifungal availability

Access to antifungal medicines varies widely around the world. In some countries these medicines are difficult to obtain or extremely expensive.

The Global Action Fund for Fungal Infections (GAFFI) has created maps showing the global availability of antifungal drugs.

View the GAFFI antifungal availability map.

Further information

Detailed information about specific antifungal drugs can be found in the Patient Information Leaflets (PIL) supplied with each medication.

Patients with aspergillosis may also receive treatment with corticosteroids or other medications depending on the type of disease.

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

Author and review information