The potential risks of treatment with terbinafine and itraconazole are discussed elsewhere in this volume. Flucytosine is an oral/intravenous drug. Potential side-effects include nausea, diarrhoea and headache, and dose-dependent bone marrow suppression. The latter occurs where plasma flucytosine levels exceed 100 mg/ml. The dose of flucytosine should be reduced in patients with renal impairment (there is a useful guide in the packet insert). Full blood and platelet counts should be followed during therapy; electrolyte and urea levels are also indicative of impending renal impairment. It is possible to monitor serum levels of flucytosine, reducing the dose if necessary. The optimum level is 40-60 mg/ml.
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