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. older adults and those with cardiac disease; . patients with chronic lung disease (including chronic obstructive pulmonary disease) associated with pulmonary hypertension; . patients receiving treatment with negative inotropic drugs, e.g. calcium channel blockers. Itraconazole should be avoided in patients with ventricular dysfunction or a history of heart failure unless the infection is serious. l CONTRA-INDICATIONS Acute porphyrias p. 1058 l CAUTIONS Active liver disease . history of hepatotoxicity with other drugs . susceptibility to congestive heart failure l INTERACTIONS → Appendix 1: antifungals, azoles l SIDE-EFFECTS GENERAL SIDE-EFFECTS ▶ Common or very common Alopecia . constipation . diarrhoea . dyspnoea . gastrointestinal discomfort. headache . heart failure . hepatic disorders . hyperbilirubinaemia . nausea . oedema . pulmonary oedema . skin reactions . vision disorders . vomiting ▶ Uncommon Hearing loss .taste altered ▶ Rare or very rare Angioedema . hypersensitivity vas

Triazole antifungals Triazole antifungal drugs have a role in the prevention and systemic treatment of fungal infections. Fluconazole is very well absorbed after oral administration. It also achieves good penetration into the cerebrospinal fluid to treat fungal meningitis. Fluconazole is excreted largely unchanged in the urine and can be used to treat candiduria. Itraconazole is active against a wide range of dermatophytes. Itraconazole capsules require an acid environment in the stomach for optimal absorption. BNF 78 Fungal infection 591 Infection 5 Itraconazole has been associated with liver damage and should be avoided or used with caution in patients with liver disease; fluconazole is less frequently associated with hepatotoxicity. Posaconazole is licensed for the treatment of invasive fungal infections unresponsive to conventional treatment. Voriconazole is a broad-spectrum antifungal drug which is licensed for use in life-threatening infections. Imidazole antifungals The imidazol