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Griseofulvin Cite this Page
Jazmine M. Olson; Todd Troxell.
Author Information
Last Update: August 2, 2021.
In this Page
Continuing Education Activity
Continuing Education Activity Go to: Indications
Griseofulvin is FDA approved for and the drug of choice in tinea capitis. Other indications include Mechanism of Action
onychomycosis as well as superficial fungal infections resistant to topical antifungal medications.
Administration
This activity will highlight the mechanism of action, adverse event profile, monitoring, and relevant
interactions of griseofulvin, pertinent for members of the interprofessional team in the treatment of Adverse Effects
patients with the conditions mentioned above when using griseofulvin.
Contraindications
Objectives: Monitoring

Describe the therapeutic mechanism of action of griseofulvin. Enhancing Healthcare Team Outcomes

Summarize the organisms for which griseofulvin is an indicated therapy. Review Questions

Outline the contraindications and adverse events associated with griseofulvin therapy. References

Explain the importance of improving care coordination among the interprofessional team to
enhance the delivery of care for patients who can benefit from therapy with griseofulvin.
Related information
Access free multiple choice questions on this topic. PMC

PubMed
Indications Go to:

Griseofulvin is FDA approved for and also the drug of choice in tinea capitis, although itraconazole
and terbinafine have come to be more common choices than griseofulvin for tinea capitis in adults. Similar articles in PubMed
[1] It is the most commonly prescribed medication for tinea capitis treatment in children due to its Review Oral griseofulvin remains the treatment of
cost-effectiveness and easy accessibility.[2] Researchers found that among antifungal therapies for choice for tinea capitis in children.
[Pediatr Dermatol. 2000]
tinea capitis, griseofulvin and terbinafine had the highest clinical and complete cure rates.[2] In the In vitro pharmacodynamic characteristics of griseofulvin
same study, griseofulvin more effectively treated Microsporum than Trichophyton. However, it is against dermatophyte isolates of Trichophyton
[Med Mycol.
tonsurans
2009]
from tinea capitis patients.
essential to note that in the United States, the most common causative agent of tinea capitis is Terbinafine hydrochloride oral granules versus oral
Trichophyton tonsurans. The efficacy of griseofulvin is improved when used in combination with griseofulvin suspension in children
[J Am with
Acadtinea
Dermatol.
capitis:2008]
results of two randomized, investigator-blinded,
selenium sulfide shampoo. Review Systemic antifungal therapy for tinea capitis in
children. [Cochrane Database Syst Rev. 2016]
Griseofulvin is also indicated in onychomycosis, although newer antifungals such as terbinafine,
Review Tinea capitis: diagnostic criteria and treatment
itraconazole, and fluconazole have largely replaced it.[3] The cause of the majority of
options. [Dermatol Nurs. 2009]
onychomycosis is T. rubrum and T. interdigitale.[4] There is high-quality evidence that compared to
placebo, it is an effective treatment for onychomycosis regarding both clinical and mycologic See reviews...
cures. Treatment is partly dependent on the rate of nail growth. Toenails grow at a slower rate than See all...
fingernails, sometimes taking as long as 12 to 18 months to achieve full growth, and therefore
demonstrate a decreased rate of treatment success.[5][6] Nail debridement may assist in the success
of treatment.[4] Recent Activity
Turn Off Clear
Additionally, griseofulvin can treat superficial fungal infections that are resistant to treatment with
topical antifungal medications, with the exception being tinea capitis, for which it is first-line, as Griseofulvin - StatPearls

mentioned above. It is usually the first-line choice for this purpose in children. Practitioners can use
it for severe and diffuse superficial fungal infections. Examples of such infections include tinea Topical Corticosteroids - StatPearls

manuum, tinea unguium, tinea corporis, and tinea cruris.

Seborrheic Dermatitis - StatPearls
Mechanism of Action Go to:
Topical anti-inflammatory agents for seborrhoeic
Griseofulvin is a microtubule assembly inhibitor. It interacts with microtubules to affect the dermatitis of the face or scalp
formation of the mitotic spindle. This interference ultimately inhibits mitosis in dermatophytes. With Control of scabies in a tribal community using mass
this mechanism, griseofulvin serves as a fungistatic agent against Trichophyton, Microsporum, and screening and treatment with...
Epidermophyton species.[2] It is noteworthy that it is ineffective in treating dimorphic fungi, yeast
See more...
(Malassezia, Candida), or chromomycosis. Griseofulvin is quickly eliminated from the body and
thus must be taken over an extended period to have efficacy.[2]

Administration Go to:

Griseofulvin is an oral medication. It comes in microsize (250 and 500 mg tablets) and ultra micro-
size (125 and 250 mg tablets) forms. Ultra micro-size tablets are absorbed better than microsize.
Griseofulvin is poorly soluble in water. Griseofulvin is best taken with a high-fat meal to increase
absorption from the GI tract.[2] The duration of therapy is long (e.g., 6 to 12 weeks for tinea capitis),
potentially leading to non-compliance. It is also available in a liquid suspension formulation. Each
of these medications should be taken daily for the indicated duration and continued until the patient
is clinically asymptomatic.

Microsize Dosing

Onychomycosis: 1000 mg daily divided from once to 4 times daily. Duration is 4 months for
fingernails and 6 months for toenails.

Tinea pedis: 1000 mg daily divided from once to four times a day for 4 to 8 weeks, in
conjunction with a topical antifungal.

Tinea corporis/cruris: 500 mg daily divided from once to four times a day for 2 to 4 weeks.

Tinea capitis: 500 mg daily divided from once to four times a day for 4 to 6 weeks.

Tinea barbae: 500 mg daily divided from once to four times a day for 4 to 8 weeks.

Ultramicrosize Dosing

Tinea capitis, barbae, corporis, or cruris: 375 mg daily divided from once to three times a day
for 2 to 4 weeks (tinea barbae, corporis, cruris) or 4 to 6 weeks (tinea capitis).

Griseofulvin requires no dose adjustment in renal impairment but is contraindicated in hepatic

failure.

Adverse Effects Go to:

Overall, griseofulvin has few adverse effects. It most commonly causes gastrointestinal issues of
nausea, vomiting, and diarrhea, as well as headaches and allergic reactions.[3] Other adverse effects
include photosensitivity, fixed drug eruption, petechiae, pruritus, and urticaria. It may cause a
worsening of lupus or porphyria.[7]

Griseofulvin is an inducer of cytochrome P-450 and thus interacts with medications that metabolize
via the P-450 system. One such drug is warfarin. When taken with griseofulvin, warfarin's
anticoagulation effect decreases.[8] Additionally, griseofulvin increases the effects of alcohol and
may cause a disulfiram-like reaction.[9]

A study involving 295 children, 79 (or 26.8%) experienced mild to moderate adverse effects, with
the most common being gastrointestinal. These included elevated triglycerides (1/79), anemia
(2/79), SGOT (serum glutamic-oxaloacetic transaminase; 1/79), rash (1/79), abdominal pain (10/79),
diarrhea (7/79), dyspepsia (3/79), fever (1/79), headache (12/79), nausea (9/79), weight gain (3/79),
vomiting (12/79), and other unspecified events (17/79).[2] All of these adverse effects were
transient, and none were considered severe.

Contraindications Go to:

Griseofulvin is a pregnancy Category C medication. It should not be prescribed to pregnant women

due to its reports of causing fetal abnormalities in rats and dogs. There are also reports of conjoined
twins in women taking griseofulvin during their first trimester of pregnancy. Patients should wait at
least a month after completion of treatment with griseofulvin before becoming pregnant.
[10] Clinicians should not use griseofulvin in a person who has a hypersensitivity to any portion of
the medication. Contraindications also include patients with hepatic failure and those with a
diagnosis of porphyria cutanea tarda.[11]

Monitoring Go to:

Whether there is a benefit to monitoring alanine aminotransferase (ALT), aspartate aminotransferase

(AST), and complete blood count (CBC) with differential is a concern for some providers
prescribing griseofulvin. A large retrospective study performed in adults and children taking
griseofulvin or terbinafine for dermatophyte infections provided clarity on this question. There was a
low rate of laboratory test result abnormalities. Most of these were low-grade and did not require
discontinuation of the medication or repeat laboratory evaluation. Elevations in ALT, elevations in
AST, anemia, lymphopenia, and neutropenia were all infrequent and comparable to baseline rates of
abnormalities. With these results, it appears unnecessary in both adults and children to perform
interval laboratory tests in patients taking griseofulvin for dermatophyte infections.[12]

Enhancing Healthcare Team Outcomes Go to:

Griseofulvin is an antifungal prescribed by clinicians (MDs, DOs, NPs, PAs), but therapy is best
managed by an interprofessional healthcare team. For example, patient education by the pharmacist
is critical if one wants to achieve good therapeutic results. Griseofulvin is not water-soluble, and
hence, patients should ingest it with a fatty diet. It has a very slow mode of action, and most
treatments require 6 to 10 weeks; therefore, patient compliance is vital.

The pharmacist should also tell the patient that the minor abdominal side effects will resolve within
a short time. Pharmacists should also perform a complete medication reconciliation to verify drug-
drug interactions that could pose an issue with griseofulvin. Nursing can promptly monitor treatment
effectiveness, patient compliance, and adverse effects from medication and report any concerns to
the healthcare team. A course with griseofulvin requires collaboration and communication from
every member of the interprofessional healthcare team for effective results and minimal adverse
effects. [Level 5]

When considering superficial fungal infections, it is essential to make an accurate diagnosis to

prevent treatment failure. However, it is also necessary to treat the infection promptly to prevent the
spread of infection and its sequelae. In particular, tinea capitis can lead to permanent baldness,
which can have a serious psychosocial effect on children. Therefore, it is important to diagnose and
treat tinea capitis early in its course. Providers should be aware that current doses of griseofulvin are
effective and safe to use for tinea capitis in children. [Level 1]

It merits mentioning that griseofulvin is ineffective in treating dimorphic fungi, yeast (Malassezia,
Candida), or chromomycosis. It has been incorrectly prescribed to treat diseases caused by these
organisms, such as candidal intertrigo, for which it is ineffective. This situation causes frustration
and disappointment for patients, as well as a delay in the resolution of infection and increased risk of
spread to others. Providers should be aware that griseofulvin is only effective against Trichophyton,
Microsporum, and Epidermophyton species and not against the organisms noted above. [Level 1]

Finally, as mentioned above in the "Monitoring" section, it appears unnecessary to perform interval
laboratory test monitoring, including AST, ALT, and CBC, in patients taking griseofulvin. Providers
are often hesitant to provide these oral medications to patients with superficial dermatophyte
infections. Because laboratory tests are costly to the healthcare system and both inconvenient and
stressful for patients, providers should be aware that interval laboratory test monitoring has not
demonstrated benefit in patients taking griseofulvin for dermatophyte infections. [Level 3]

Review Questions Go to:

Access free multiple choice questions on this topic.

Comment on this article.

References Go to:

1. Elghblawi E. Tinea Capitis in Children and Trichoscopic Criteria. Int J Trichology. 2017 Apr-
Jun;9(2):47-49. [PMC free article] [PubMed]
2. Gupta AK, Mays RR, Versteeg SG, Piraccini BM, Shear NH, Piguet V, Tosti A, Friedlander SF.
Tinea capitis in children: a systematic review of management. J Eur Acad Dermatol Venereol.
2018 Dec;32(12):2264-2274. [PubMed]
3. Kreijkamp-Kaspers S, Hawke K, Guo L, Kerin G, Bell-Syer SE, Magin P, Bell-Syer SV, van
Driel ML. Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev.
2017 Jul 14;7:CD010031. [PMC free article] [PubMed]
4. Gupta AK, Foley KA, Versteeg SG. New Antifungal Agents and New Formulations Against
Dermatophytes. Mycopathologia. 2017 Feb;182(1-2):127-141. [PubMed]
5. Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia. 2008
Nov-Dec;166(5-6):353-67. [PubMed]
6. Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based
review. Am J Clin Dermatol. 2014 Dec;15(6):489-502. [PubMed]
7. Chaudhary RG, Rathod SP, Jagati A, Zankat D, Brar AK, Mahadevia B. Oral Antifungal
Therapy: Emerging Culprits of Cutaneous Adverse Drug Reactions. Indian Dermatol Online J.
2019 Mar-Apr;10(2):125-130. [PMC free article] [PubMed]
8. Blank H. The actions and interactions of drugs: the therapeutic significance of enzyme
induction. Trans St Johns Hosp Dermatol Soc. 1967;53(1):1-23. [PubMed]
9. Katz HI. Systemic antifungal agents used to treat onychomycosis. J Am Acad Dermatol. 1998
May;38(5 Pt 3):S48-52. [PubMed]
10. Smith EB. The treatment of dermatophytosis: safety considerations. J Am Acad Dermatol.
2000 Nov;43(5 Suppl):S113-9. [PubMed]
11. Spiro JM, Demis DJ. The effects of griseofulvin on porphyria cutanea tarda. J Invest Dermatol.
1968 Mar;50(3):202-7. [PubMed]
12. Stolmeier DA, Stratman HB, McIntee TJ, Stratman EJ. Utility of Laboratory Test Result
Monitoring in Patients Taking Oral Terbinafine or Griseofulvin for Dermatophyte Infections.
JAMA Dermatol. 2018 Dec 01;154(12):1409-1416. [PMC free article] [PubMed]

Copyright © 2021, StatPearls Publishing LLC.

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