Imidazole

Imidazole antifungals (clotrimazole, miconazole, ketoconazole, econazole) inhibit lanosterol 14-α-demethylase (CYP51), a cytochrome P450 enzyme essential for converting lanosterol to ergosterol in fungal cell membranes. Ergosterol depletion and accumulation of toxic 14-α-methylsterols increase membrane permeability and disrupt membrane-bound enzyme function. Imidazoles are less selective for fungal CYP51 than triazoles, which limits systemic use due to mammalian steroidogenesis inhibition.

Adult

avoided by reducing the dose or by using alternative drugs. Special care is required in renal transplantation and immunosuppressed patients; if necessary such patients should be referred to specialists. For guidance on prescribing in patients with renal impairment, see Prescribing in renal impairment p. 23.…