Risk/benefit ratio of modern antifungal therapy: focus on hepatic reactions.

The purpose of this article is to review the risk/benefit ratio of the oral antifungals: griseofulvin, ketoconazole, fluconazole, itraconazole, and terbinafine. The reported side effects of each drug have been listed with particular emphasis on the possibility of hepatic damage. All oral antifungal agents cause minor gastrointestinal upset, as well as headache and skin reactions. There is also a rare incidence of reversible hepatic damage. Although the incidence of abnormal liver function tests from oral antifungal therapy is extremely low, patients should be advised to inform their physician if any warning symptoms are noticed.