Generic Name: griseofulvin
Brand Names: Gris-PEG, Grifulvin V (discontinued brand)
Drug Class: Antifungals, Systemic
What is griseofulvin, and what is it used for?
Griseofulvin is an antibiotic derived from Penicillium species of fungi used to treat ringworm infections caused by specific fungi species. Griseofulvin is a systemic drug used only to treat fungal infections that are refractory to topical antifungal treatments and not for minor infections.
The type of fungi responsible for the infections should be first identified before starting griseofulvin therapy. Griseofulvin is effective for infections from various species of Microsporum, Epidermophyton and Trichophyton, but has no effect on bacteria or other genera of fungi.
Griseofulvin prevents fungal growth by inhibiting fungal DNA synthesis and cell division. Oral griseofulvin is absorbed systemically and is deposited in keratin, a type of protein in epithelial cells that line the outer surface of the body and the surfaces of inner organs. Keratin is found in skin, nail, hair, and hair follicles. Griseofulvin binds with new keratin that forms in the epithelial cells making it highly resistant to fungal growth. The fungal infection clears as the old infected cells are shed and the resistant cells form the new skin layer.
Griseofulvin is used in the treatment of the following fungal infections:
- Skin (tinea barbae)
- Scalp (tinea capitis)
- Jock itch (tinea cruris)
- Athlete’s foot (tinea pedis)
- Nails (tinea unguium/onychomycosis)
- Hands (tinea manuum), off-label
Griseofulvin has no effects against bacterial infections, candidiasis, tinea versicolor, and other types of fungal infections. Griseofulvin is active against only the following species of fungi:
Trichophyton rubrum, Trichophyton tonsurans, Trichophyton mentagrophytes, Trichophyton interdigitalis,Trichophyton verrucosum, Trichophyton megnini, Trichophyton gallinae, Trichophyton crateriform, Trichophyton sulphureum, Trichophyton schoenleini, Microsporum audouini, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum.
Warnings
- Do not use griseofulvin in the following conditions:
- Do not use griseofulvin for prevention of fungal infections.
- Griseofulvin can cause severe life-threatening skin reactions such as Stevens-Johnson syndrome. Discontinue the drug if the patient develops severe skin reactions.
- Griseofulvin can be toxic to the liver. Monitor patient’s liver function and discontinue if they develop jaundice or elevated liver enzymes.
- Monitor patient’s liver and kidney functions and complete blood count periodically in case of prolonged griseofulvin therapy.
- There is a possibility of cross-sensitivity with penicillin because griseofulvin is derived from Penicillium, however, penicillin-sensitive patients have been treated successfully. Exercise caution.
- Development of lupus erythematosus, lupus-like syndromes or exacerbation of existing lupus erythematosus has been reported.
QUESTION
Ringworm is caused by a fungus.
See Answer
What are the side effects of griseofulvin?
Common side effects of griseofulvin include:
- Skin hypersensitivity reactions such as:
- Rash
- Hives (urticaria)
- Erythema multiforme-like red, raised lesions
- Light sensitivity (photosensitivity)
- Oral thrush (candidiasis)
- Nausea
- Vomiting
- Epigastric distress
- Diarrhea
- Headache
- Fatigue
- Dizziness
- Insomnia
- Drowsiness
- Mental confusion
- Irritability
Less common side effects of griseofulvin include:
- Impaired coordination
- Peripheral nerve disease (neuropathy)
- Loss of appetite (anorexia)
- Gastrointestinal bleeding
- Taste sensation changes
Rare side effects of griseofulvin usually with high doses, long treatment duration or both:
- Kidney disorder (nephrosis)
- Excessive protein in the urine (proteinuria)
- Liver toxicity
- Increase in serum bilirubin
- Increase in liver enzymes (transaminases)
- Reduced count of granulocyte immune cells in blood (granulocytopenia)
- Reduced leukocyte immune cells in blood (leukopenia)
- Low red blood cell count (anemia)
- Numbness and tingling (paresthesia) of hands and feet
- Swelling of tissue under the skin and mucous membranes (angioneurotic edema)
- Drug-induced lupus-like syndrome
- Severe skin reactions including:
- Stevens-Johnson syndrome
- Toxic epidermal necrosis
- Menstrual irregularities
Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:
- Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
- Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
- Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
- Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of griseofulvin?
Oral suspension, microsize
- 125 mg/5 ml
Tablet, microsize
- 500 mg (Grifulvin V)
Tablet, ultramicrosize
- 125 mg (Gris-PEG)
- 250 mg (Gris-PEG)
Tinea Infection
Infections affecting skin, body, hair/beard, or nails
Adult:
Microsize
- Tinea corporis, cruris, or capitis: 500 mg/day orally
- Tinea pedis or unguium: 1000 mg/day orally as a single daily dose or divided every 12 hours
Ultramicrosize
- Tinea corporis, cruris, or capitis: 375 mg/day orally
- Tinea pedis or unguium: 250 mg orally every 8 hours
Pediatric:
- Children under 2 years old: safety and efficacy not established
Microsize
- 11 mg/kg/day orally as a single dose or divided every 12 hours
- Children 13.6-22.7 kg (30-50 lb): 125-250 mg/day
- Children over 22.7 kg (over 50 lb): 250-500 mg/day
- Off-label: 10-20 mg/kg/day divided every 12 hours
Ultra-micro-size
- 7.3 mg/kg/day orally
- Children 13.6-22.7 kg (3-50 lb): 82.5-165 mg/day
- Children over 22.7 kg (over 50 lb): 135-330 mg/day
- Off-label: 5-15 mg/kg/day orally divided every 12 hours; not to exceed 750 mg/day
Treatment duration
- Dependent on infection site
- Tinea corporis: 2-4 weeks
- Tinea capitalize: 4-6 weeks; maybe up to 8-12 weeks
- Tinea pedis: 4-8 weeks
- Tinea unguium: 4-6 months
Dosing considerations:
- Absorption increased with fatty meals
Overdose
- There are no known reports of griseofulvin overdose. Overdose symptoms may include nausea, vomiting, headache, skin eruptions, numbness and tingling, vertigo and confusion.
- There is no specific antidote for griseofulvin and overdose is treated with symptomatic and supportive care. Undigested drug in the stomach may be eliminated with induced vomiting or gastric lavage and activated charcoal administration.
What drugs interact with griseofulvin?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Griseofulvin has no known severe interactions with other drugs.
- Griseofulvin has serious interactions with 23 different drugs.
- Griseofulvin has moderate interactions with 112 different drugs.
- Griseofulvin has minor interactions with 61 different drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
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Pregnancy and breastfeeding
- Do not use griseofulvin during pregnancy. Animal studies show evidence of fetal harm with griseofulvin use during pregnancy. There are reports of conjoined twins in two pregnant women who took griseofulvin in the first trimester of pregnancy.
- Women of pregnancy potential must use effective contraception during griseofulvin therapy and for at least a month after completion of treatment.
- Animal studies show griseofulvin can cause chromosomal aberrations in males. Men should practice effective contraception during therapy and for 6 months after completion of treatment.
- It is not known if griseofulvin is excreted in breast milk. Avoid use in nursing mothers.
What else should I know about griseofulvin?
- Take griseofulvin exactly as prescribed. Take with a fatty meal to improve drug absorption and prevent gastrointestinal upset.
- Check with your healthcare provider for periodic tests if you are on prolonged therapy.
- Avoid exposure to intense sunlight while on griseofulvin therapy, it may cause photosensitive reactions.
- Avoid drinking alcohol while on griseofulvin therapy, it may potentiate alcohol effects, causing symptoms such as rapid heartbeat (tachycardia) and flushing.
- Store griseofulvin carefully out of reach of children.
- In case of accidental overdose, seek medical help immediately or contact Poison Control.