Antifungals (Fluconazole, Itraconazole)
Common brand names: Diflucan, Sporanox, Vfend, Noxafil, Lamisil (systemic)
Three nutrients listed against this medication. The most severe is marked moderate.
At a glance
None of the three is marked well documented. Each row carries its own evidence level.
At a glance
- MagnesiumModerate · Traditionally cited, limited evidence
- CoQ10Mild · Mechanism only, no human trial
- Vitamin D3Mild · Mechanism only, no human trial
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Azole antifungals inhibit sterol-pathway enzymes, and CoQ10 synthesis branches off the same upstream mevalonate pathway that statins act on. The shared pathway is real; no human trial has measured a CoQ10 fall during antifungal therapy, so the depletion step is inference.
Common signs, Fatigue, cardiac side effects (particularly with itraconazole), muscle weakness
Azole antifungals inhibit the mevalonate/sterol pathway shared with CoQ10 synthesis (mechanistic). No human trial has measured a CoQ10 fall on antifungal therapy.
CoQ10 200 mg daily during and after an azole course is a figure in common use, not from a trial cited on this row. No human trial has measured CoQ10 on antifungal therapy.
Mechanism, Amphotericin B causes severe renal magnesium wasting. Azole antifungals have lesser but measurable renal magnesium effects with prolonged use.
Common signs, Muscle cramps, cardiac arrhythmia, neurological symptoms with severe depletion
Magnesium wasting is specific to amphotericin B, a different (IV) antifungal; it does not apply to azole antifungals. On azole therapy specifically this row is retained as a monitoring note only, not as a depletion claim.
Magnesium glycinate was used at 300–400 mg daily during antifungal therapy; IV magnesium may be required with amphotericin B.
Mechanism, Azole antifungals inhibit vitamin D hydroxylases including CYP27B1 in vitro, which in principle would impair vitamin D activation without necessarily moving a standard 25(OH)D result. The in-vitro inhibition is established; a fall in vitamin D status on standard antifungal courses has not been demonstrated in patients.
Common signs, Functional Vitamin D deficiency despite normal 25(OH)D, immune impairment, bone effects
Azoles inhibit vitamin D hydroxylases in vitro; a fall in serum 25(OH)D on standard antifungal therapy has not been demonstrated in patients.
Vitamin D3 2,000–4,000 IU is a range in common use, not from a trial cited on this row. The row's own evidence states that a fall in serum 25(OH)D on standard antifungal therapy has not been demonstrated in patients, so there is no threshold here to correct toward.
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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