Azoles

<p>From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia</p>

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ketoconazole (Nizoral, Fungoral, Oronazol, Ketazol)

fluconazole (Diflucan, Fungata, Mycosyst, Flucomicon, Baten)

itroconazole (Sporanox, Orungal, Isox)

These antifungal drugs belong to a group called azoles (other drugs whose names end –azole such as omeprazole or aripiprazole are not azoles). Unlike nystatin, they can be used for fungal infections situated anywhere in the body. Itroconazole and fluconazole have a broader spectrum of action than ketoconazole, which is mostly used against candida. Fluconazole is the most commonly used of these three, especially in CFS/ME.97 A commonly prescribed regime is 100–200 mg a day for 3–6 weeks.

Relief in symptoms can apparently be experienced in a matter of a few days. Jacob Teitelbaum treats patients with interstitial cystitis for candida with a three–month course of fluconazole 98 He also uses it for chronic sinusitis. Devin Starlanyl sometimes tries it for fibromyalgia patients whose cognitive problems, depression, IBS or sleep disturbances she suspects to be caused by yeast.99

Stomach upset and pruritus (itching) are the most common side effects of the azoles. Some patients have reported worsening of fatigue from fluconazole, which may persist for a while after the medication has been discontinued. Ketoconazole reduces the production of testosterone and glucocorticoids. Fluconazole may prolong the QT interval. All of the azoles can cause hepatotoxicity, so liver monitoring may be warranted.

Azoles can interact with many other drugs, such as macrolides, carbamazepine, buspirone, reboxetine, calcium channel blockers and many benzodiazepines. Drugs that reduce stomach acidity (such as H2 blockers and proton pump inhibitors) may reduce the absorption of ketoconazole and itroconazole. Ketoconazole and magnesium should be taken at different times of the day.

Itroconazole is available in the United States, the United Kingdom, Canada, Australia and many other countries. Fluconazole and ketoconazole are sold virtually everywhere. The azoles are available as capsules/tablets and oral solution. Ketoconazole is also sold in many topical formulations such as shampoo. All of these drugs are fairly expensive especially in long term use, but ketoconazole is quite a bit cheaper than the others.</p>