Griseofulvin

Aka: Griseofulvin, Gris-Peg

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II. Indications

  1. Tinea Capitis
  2. Other indications (other Antifungals are preferred)
    1. Tinea Corporis
    2. Tinea Pedis
    3. Onychomycosis

III. Contraindications

  1. Hepatic Failure
  2. Porphyria

IV. Mechanism

  1. Antifungal derived first in 1958 from the mold Penicillium griseofulvum
  2. Inhibits fungal cell division by inhibiting microtubule function in Mitosis
    1. Binds tubulin in fungi and disrupts mitotic spindles
  3. Griseofulvin is fungistatic (NOT fungicidal)
    1. It suppresses fungal growth, but does not kill fungal organisms
  4. Griseofulvin deposits in keratin precursor cells of the skin, hair and nails
    1. As superficial, keratinized skin cells slough
    2. Griseofulvin infused cells gradually rise to the surface, slowly eliminating the infection

V. Medications

  1. Griseofulvin Microsize
    1. Tablets: 500 mg
    2. Suspension: 125 mg/5 ml
  2. Griseofulvin Ultramicrosize
    1. Tablets: 125 mg, 250 mg

VI. Dosing: Tinea Capitis

  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

VII. Adverse Effects

  1. Photosensitivity
  2. Drug-induced Lupus (or exacerbation of pre-existing Systemic Lupus Erythematosus)
  3. Other uncommon adverse effects
    1. Headache
    2. Nausea or Vomiting
    3. Bone Marrow suppression (Leukopenia)

VIII. Safety

  1. Avoid in pregnancy (Teratogenic)
  2. Unknown safety in Lactation

IX. Drug Interactions

  1. Warfarin
    1. Decreases INR
  2. Oral Contraceptives
    1. Decreases efficacy (use reliable Contraception)

X. Efficacy

  1. Very effective for Tinea Capitis with >2 months of use
  2. Not as effective for Tinea Unguium (Onychomycosis)

XI. 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

XII. Resources

  1. Griseofulvin Tablets (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=98829d90-b289-4bec-a625-7af412a5cb2d

XIII. References

  1. Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]

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Cost: Medications

griseofulvin (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
GRISEOFULVIN 125 MG/5 ML SUSP Generic $0.41 per ml
GRISEOFULVIN MICRO 500 MG TAB Generic $7.40 each
GRISEOFULVIN ULTRA 250 MG TAB Generic $4.45 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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