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Fluconazole alternatives: What can I take instead of fluconazole?

Explore safe, effective antifungal alternatives when fluconazole isn’t the right fit.
pill vs. cream bottle: best fluconazole alternatives

Key takeaways

  • Fluconazole (Diflucan) is an antifungal medicine prescribed to treat various fungal infections, such as oral thrush and candidiasis.

  • Some common oral fluconazole alternatives include Lamisil, Monistat, itraconazole, voriconazole, and amphotericin B.

  • For mild cases, certain supplements—probiotics, prebiotics, and vitamin D—along with dietary and lifestyle changes may help.

Fluconazole (brand name: Diflucan) is an antifungal medication that’s commonly prescribed to treat fungal or yeast infections of the mouth, throat, abdomen, vagina, lungs and bloodstream. It is also used to prevent infection in people who need bone marrow transplants. And while it’s effective against those infections, it’s not the best option for everyone who experiences them. Allergies, side effects, drug interactions, and pregnancy might all send patients in search of alternatives. 

Good news: there are plenty of options for people who can’t, or don’t want to, take fluconazole. We’ve outlined some of the most common ones below. 

What can I take in place of fluconazole?

There’s a range of medications on the market that can treat fungal or yeast infections. Nearly all of them fall under the broad antifungal umbrella, but there are some notable differences between them. “Azole antifungals” are popular choices, and there are other options besides fluconazole. 

However, synthetic antifungals called allylamines, semi-synthetic antifungals called echinocandins, and organic options called polyenes can all be viable alternatives. Antifungals can also come in oral, topical, or intravenous formulations. The best option depends on the individual’s specific condition, medical history, other medications, and preferences. 

Compare fluconazole alternatives

Drug name Uses Dosage Savings options
Fluconazole Wide spectrum of yeast and fungal infections 200–400 mg the first day, then 100–200 mg daily Fluconazole coupons
Sporanox (itraconazole) Various fungal infections 200–400 mg per day Sporanox

coupons

Vfend (voriconazole) Various fungal infections A loading dose from the doctor, then 100–200 mg every 12 hours Vfend coupons
Nystop (nystatin) Vaginal yeast infections and fungal infections of the skin, mouth, and esophagus Oral: 1–2 tablets 3–5 times per day.

Topical: Apply to affected area 2–3 times per day

Nystop coupons
Monistat (miconazole) Vaginal yeast infections 100 mg daily for 7 days, 200 mg daily for 3 days, or one 1,200 mg dose Monistat coupons
Lamisil (terbinafine) Fungal infections of the fingernails or toenails 250 mg per day Lamisil coupons
Fungizone (Amphotericin B ) Life-threatening fungal infections 0.25–1 mg/kg of body weight Fungizone coupons

Other alternatives to fluconazole

  • Terconazole
  • Posaconazole
  • Tioconazole
  • Clotrimazole
  • Econazole
  • Naftifine
  • Tolnaftate
  • Liranaftate
  • Griseofulvin
  • Flucytosine
  • Caspofungin
  • Micafungin
  • Anidulafungin

Top 7 fluconazole alternatives

While plenty of antifungals have the potential to serve as substitutes for fluconazole, some are more direct replacements than others. Here are a few of the most common:

1. Sporanox (itraconazole)

Also an azole antifungal, itraconazole is fairly similar to fluconazole, and studies have shown that they’re both effective at inhibiting the growth of the candida albicans (C. albicans) fungus. And while they’re both oral antifungals, itraconazole is often used for nail fungus and severe fungal infections, while fluconazole is more common for vaginal yeast infections and oral thrush. “The catch? It needs to be taken with food and acid to be absorbed properly, and it interacts with a number of medications,” says Dr. Pamela Tambini, MD, Physician & Medical Director at Engage Wellness. “We usually monitor liver function and heart health closely when prescribing it.”

2. Vfend (voriconazole)

Another oral azole antifungal, voriconazole, functions similarly to fluconazole and itraconazole. Some research suggests they’re also similarly effective for oral thrush, although voriconazole has a broader treatment spectrum and might be prescribed for more severe infections. However, it also comes with more potential serious effects

3. Nystop (nystatin)

Belonging to a drug class called polyenes, this is “a great choice for treating superficial infections like oral thrush or skin yeast infections,” says Dr. Tambini. “It’s not absorbed into the bloodstream, so it’s perfect for topical or localized use but won’t help with deep or systemic infections.” Its most common potential side effects are mainly gastrointestinal, like nausea and diarrhea. 

4. Lamisil (terbinafine)

Lamisil is in the allylamine class of antifungals, and it’s primarily used as a topical treatment for fungal nail and skin infections like ringworm and athlete’s foot, while fluconazole often treats systemic infections. It can cause dermal side effects like itching and hives, but it has fewer drug interactions than fluconazole. 

5. Monistat (miconazole)

Monistat is another azole antifungal, but one that’s primarily used for vaginal yeast infections. Unlike fluconazole, which is an oral medication, Monistat comes as a cream and a vaginal suppository. Both drugs work for these infections, but a 2015 study showed that Monistat could work faster to relieve some symptoms. However, its side effects can include local irritation, burning, and itching.

6. Echinocandins (Caspofungin, Micafungin, Anidulafungin)

These antifungal drugs are typically administered intravenously instead of orally, and they’re preferred for forms of invasive fungal infections, or infections that are resistant to fluconazole. They may also be more effective for mycological eradication and have fewer potential drug interactions. As an intravenous drug, side effects may include infusion reactions.

7. Amphotericin B (Fungizone)

This is a polyene antifungal administered orally, intravenously, or via injection. It’s typically used for serious and potentially life-threatening fungal infections, while fluconazole often treats milder cases confined to the Candida species. However, amphotericin also has a higher risk of side effects, including serious ones. 

“Amphotericin B is especially potent, but it can be hard on the kidneys, so it’s used with caution and under close medical supervision,” Dr. Tambini says.

Natural alternatives to fluconazole

Nature has some of its own antifungals. They aren’t as potent or targeted as medications, but they might help manage symptoms of mild fungal growth. For example, probiotics and prebiotics might help by improving the body’s “good bacteria,” while vitamin D may also have antifungal properties. These supplements are often available over the counter. 

Other natural antifungals include garlic, tea tree oil, oregano, thyme, peppermint, ginger, rosemary, and honey. These may be available as supplements and can be worked into an existing diet as well. Some people even try a “candida diet,” which involves eliminating highly processed foods; however, this might not have any effect on infections, even though it promotes good health in general. 

Maintaining good cleanliness and hygiene, particularly around the nails, mouth, and vagina, can help prevent fungal infections from taking root. Wearing breathable footwear may help keep athlete’s foot at bay, and avoiding sharing personal items like toothbrushes can prevent fungus from spreading. 

“But here’s the thing—these remedies aren’t substitutes for prescription antifungals, especially when dealing with internal or widespread infections,” Dr. Tambini says. “Natural options can sometimes help with symptom relief or serve as a preventive measure, but I always recommend talking with your healthcare provider before trying them, especially if you’re immunocompromised or dealing with a persistent infection. Some natural remedies can cause irritation or allergic reactions, and not all are backed by strong clinical evidence.”

And according to Dr. Viktoryia Kazlouskaya, MD, owner of Dermatology Circle, “there is less research on natural treatments. Tea tree oil and vinegar are probably the two most well-known natural remedies. I always warn patients, though, that we don’t have enough scientific data to support using natural treatments alone.”

How to switch to a fluconazole alternative

If you’ve decided to switch from fluconazole to an alternative, the first step is to consult a healthcare provider. They’ll help determine which might be the best option for you and explain when you should make the transition. “Switching antifungal medications isn’t something we do casually—it requires understanding why fluconazole isn’t working,” Dr. Tambini says.

And according to Dr. Kazlouskaya, “the decision to switch should be based on clinical presentation, response to treatment, and current symptoms. At times, the doctor may order additional tests (like cultures) to identify the exact fungus and determine what medication would be most effective. Lack of symptom resolution after a few weeks can also indicate that the medication should be changed.”

Don’t stop taking fluconazole without talking to your healthcare provider, even if you feel better, since the infection might return. Once you have a new prescription or recommendation from your healthcare provider, follow their dose instructions exactly and inform them if you experience any side effects after the switch.