Sporanox (Itraconazole)
Sporanox is a "cousin" of Diflucan, approved by the FDA for use against thrush (candida infections in the mouth and throat).
Available in the United States since 1993, Sporanox is highly successful in eliminating the symptoms of thrush within seven to 14 days and has been clinically proven effective in some patients who are resistant to Diflucan, usually at a level of about 100 mg. once daily. Higher dosages (about 200 mg. a day) are usually prescribed for patients with persistent vaginal yeast infections.
Charles Resseger, D.O., of Norwalk, Ohio, told me he finds that Diflucan and Sporanox work synergistically and are often very effective in patients who don't respond to Diflucan alone.
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Other physicians have told me they prefer Sporanox for yeast-related skin conditions, and some say it is especially effective for patients with chemical sensitivity.
"In some patients, it just pulls them completely out of this complex illness that has been devastating them," says Boca Raton, Florida osteopathic physician AI Robbins, D.O. Dr. Robbins told me he uses a capsule a day for about 14-30 days for the best results, but warns that there seems to be more side effects with Sporanox than with other azoles.
In 2001, the FDA warned: Sporanox has been associated with rare cases of congestive heart failure and liver damage when used by patients with fungal infections of the fingernails and toenails. It should not be used by patients with a history of congestive heart failure or ventricular dysfunction.
Sporanox is less expensive than Diflucan, at about $3 a pill.
Nizoral (Ketoconazole)
This potent systemic anticandida drug was introduced in the United States in 1981 and was found to be effective in helping many people with yeast-related problems.
It's usually used in 200 to 400 mg. doses taken once a day. It's by far the least expensive at about $1.25 a pill, but it does have some side effects.
The manufacturer notes: Nizoral is known to suppress hormone production, especially at high doses over an extended period of time. Nizoral has caused liver problems in one of 10,000 patients who take it, so anyone taking it should have liver function monitored monthly, more often if more than 200 mg. daily is prescribed.
If you've had a history of liver disease, I'd recommend avoiding Nizoral. It has been shown to be particularly toxic if used in combination with alcohol.
Nizoral should not be taken in combination with the antihistamine Seldane because the two drugs in combination can cause irregular heartbeats.
Another Azole - Miconazole
This generic antifungal is the main ingredient in Monistat, the anti-yeast cream sold over the counter in the United States. While the cream would not be effective against systemic candida overgrowth, miconazole gel is available under the brand name Daktarin in Europe, Australia and Canada and, when taken orally, may be helpful in treating vaginal yeast infections and thrush. Some of my colleagues say it is an excellent affordable alternative to the expensive azole drugs available in the United States.
It is relatively side-effect free compared to its azole cousins, with the only serious warning that it should not be taken in combination with blood thinners like warfarin (Coumadin).
A few physicians are familiar with this drug, but it is not easy to find in the United States. You can get it with a prescription through Wellness Health and Pharmaceuticals in Birmingham, Alabama (800) 227-2627.
More Azoles Are Coming
Within the coming year, look for new drugs in the azole class to be approved for the market. They have been developed mainly to address serious fungal infections in people whose immune systems are compromised.
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In January 2002, Dr. Thomas J. Walsh told the Infectious Disease Society of America that Pfizer will soon begin marketing Vfend (voriconazole), and Schering-Plough is seeking FDA approval for posaconazole and Bristol-Myers Squibb for ravuconazole.
What's more, Dr. Walsh, chief of the immuno-compromised section of the National Cancer Institute in Bethesda, Maryland, predicted more antifungal agents called echinocandins that target the fungal cell wall, will soon be available to the public. Cancidas, the first echocandin produced by Merck and Co., recently gained approval but as of 2005, it is only available by IV administration. To find out more, you can check out Natural Cures For Yeast Infections.