Antifungals and Liver Damage: What You Need to Know

When you take an antifungal, a medication used to treat fungal infections like athlete’s foot, yeast infections, or systemic fungal diseases. Also known as antimycotics, these drugs stop fungi from growing—but some can also stress your liver. It’s not common, but it’s real enough that doctors check liver enzymes before and during treatment for certain antifungals. If you’ve ever been told to get blood work before starting fluconazole or itraconazole, this is why.

The liver breaks down most drugs, and some antifungals are harder on it than others. ketoconazole, an older antifungal once used for skin and systemic infections is known to cause serious liver injury—so much so that its oral form was pulled from the market in many countries. Even newer ones like voriconazole, used for invasive fungal infections in hospitals, can raise liver enzymes in up to 20% of patients. And while terbinafine is generally safer, there are still reports of rare but severe liver damage, sometimes without warning signs until it’s too late.

Who’s most at risk? People over 65, those with existing liver disease, or anyone taking multiple medications at once. Alcohol use, obesity, and certain genetic factors also play a role. It’s not just about the drug—it’s about your body’s ability to handle it. That’s why symptoms like unexplained fatigue, dark urine, yellow eyes, or belly pain shouldn’t be ignored, even if you feel otherwise fine.

You won’t get liver damage from using antifungal cream for athlete’s foot. The risk comes from pills or IV forms that enter your bloodstream. That’s why topical antifungals rarely show up in liver damage reports, while oral ones do. If you’re on long-term treatment—for example, for nail fungus or a chronic yeast infection—your doctor should monitor your liver function every few weeks. If your levels start climbing, they’ll pause the drug before real damage happens.

Some people worry they’ll miss out on treatment if they avoid antifungals entirely. But the truth is, most fungal infections can be managed safely if you’re monitored. There are alternatives, like echinocandins or newer azoles, that may be gentler on the liver. And if you’ve had a reaction before, your medical team can pick a safer option next time.

What you’ll find in the posts below are real stories and clear facts about how these drugs interact with your body. You’ll learn how to spot early warning signs, what blood tests matter most, and why switching from one antifungal to another isn’t just a guess—it’s a calculated move. There’s also advice on talking to your pharmacist about interactions, how to track side effects, and what to do if your liver enzymes go up. This isn’t fear-mongering. It’s about giving you the tools to use these medications wisely—without letting fear stop you from getting the care you need.