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Griseofulvin is FDA approved for and the drug of choice in tinea capitis. Other indications include onychomycosis as well as superficial fungal infections resistant to topical antifungal medications. 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 patients with the conditions mentioned above when using griseofulvin. Objectives: Describe the therapeutic mechanism of action of griseofulvin. Summarize the organisms for which griseofulvin is an indicated therapy. Outline the contraindications and adverse events associated with griseofulvin therapy. 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. Access free multiple choice questions on this topic.

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]

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]