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Pharmacology of azoles

Elizabeth Dodds Ashley, PharmD, MHS, BCPS
John R Perfect, MD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD


Azole antifungal agents have added greatly to the therapeutic options for treatment of systemic fungal infections. The azoles that are available for systemic use can be classified into two groups: the triazoles (fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole) and the imidazoles (ketoconazole).

An overview of the use of azole agents for the treatment of various systemic fungal infections will be reviewed here. Detailed disease-specific treatment recommendations are presented elsewhere. (See "Treatment and prevention of invasive aspergillosis" and "Treatment of chronic pulmonary aspergillosis" and "Treatment of candidemia and invasive candidiasis in adults" and "Treatment of oropharyngeal and esophageal candidiasis" and "Treatment and prevention of Fusarium infection".)

Other systemic antifungal agents, such as amphotericin B and flucytosine, are discussed separately. The use of topical antifungals for onychomycosis and dermatophyte infections is also reviewed elsewhere. (See "Pharmacology of amphotericin B" and "Pharmacology of flucytosine (5-FC)" and "Dermatophyte (tinea) infections" and "Onychomycosis: Epidemiology, clinical features, and diagnosis".)


Members of the triazole family are some of the most widely used antifungal agents [1]. The drugs in this class offer activity against many fungal pathogens without the serious nephrotoxic effects observed with amphotericin B. Newer azole agents have emerged as first-line therapies for several severe fungal diseases, such as invasive aspergillosis, for which voriconazole has become the standard of care.

There are currently five members of the triazole class licensed for use in the United States (fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole). It is important for clinicians to appreciate the unique characteristics of each member of this class in order to use azoles appropriately.

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Literature review current through: Nov 2017. | This topic last updated: Sep 11, 2017.
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