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Griseofulvin

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Griseofulvin, Gris-Peg

  • See also
  1. Antifungal Medication
  2. Topical Antifungal
  3. Tinea Capitis
  • Indications
  1. Tinea Capitis
  2. Other indications (other Antifungals are preferred)
    1. Tinea Corporis
    2. Tinea Pedis
    3. Onychomycosis
  • Contraindications
  1. Hepatic Failure
  2. Porphyria
  • Mechanism
  1. Antifungal derived first in 1958 from the mold Penicillium griseofulvum
  2. Inhibits microtubule function in mitosis by binding tubulin in fungi
  • Medications
  1. Griseofulvin Microsize
    1. Tablets: 500 mg
    2. Suspension: 125 mg/5 ml
  2. Griseofulvin Ultramicrosize
    1. Tablets: 125 mg, 250 mg
  1. General
    1. Take with food (especially a fatty meal) for better absorption
  2. Griseofulvin microsize (Griseofulvin V)
    1. Adult: 500 mg (up to 1 g) orally daily
    2. Child: 20 to 25 mg/kg/day (max 1000 mg/day, AAP dosing) orally daily until Hair Growth
  3. Griseofulvin Ultramicrosize (more expensive, but may have better absorption)
    1. Adult: 375 mg orally once daily (up to twice daily)
    2. Child: 10 to 15 mg/kg orally daily (max 750 mg/day, AAP off-label dosing)
  4. Duration
    1. Tinea Capitis: 4 to 6 weeks (up to 8 week) or 2 weeks after cultures are negative
    2. Other indication durations are listed, but other agents are preferred
      1. Tinea Corporis: 2 to 4 weeks
      2. Tinea Pedis: 4 to 8 weeks
      3. Fingernail Onychomycosis: 4 months
      4. Toenail Onychomycosis: 6 months
  • Adverse Effects
  1. Photosensitivity
  2. Drug-induced Lupus (or exacerbation of pre-existing Systemic Lupus Erythematosus)
  • Safety
  1. Avoid in pregnancy (Teratogenic)
  2. Unknown safety in Lactation
  • Drug Interactions
  1. Warfarin
    1. Decreases INR
  2. Oral Contraceptives
    1. Decreases efficacy (use reliable Contraception)
  • Efficacy
  1. Very effective for Tinea Capitis with >2 months of use
  2. Not as effective for Tinea Unguium (Onychomycosis)
  • Monitoring
  1. No baseline testing needed in the absence of liver disease
  2. Obtain labs for treatment duration >8 weeks (or history of abnormal Liver Function Tests)
    1. Liver Function Tests (ALT, AST, Serum Bilirubin) every 8 weeks
    2. Complete Blood Count (CBC) every 8 weeks
    3. Serum Creatinine every 8 weeks
  • Resources
  1. Griseofulvin Tablets (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=98829d90-b289-4bec-a625-7af412a5cb2d
  • References
  1. Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]