Grisovin FP

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Toepassingen & indicaties

Grisovin FP (griseofulvin 125 mg / 250 mg / 500 mg, GSK) is one of the oldest oral antifungal agents. It binds to fungal microtubules, disrupting mitosis and inhibiting hyphal growth. Modern practice has largely replaced it with terbinafine and itraconazole for adults — but it remains relevant when:

• Treating tinea capitis caused by Microsporum (terbinafine has lower cure rates against Microsporum than against Trichophyton).
• Treating tinea capitis in children — long-established paediatric experience and safety data.
• Newer oral antifungals are unavailable, contraindicated, or unaffordable.

Hoe in te nemen

• Take with a fatty meal — fat increases griseofulvin absorption ~2-fold.
• For children, the tablet can be crushed into food or yogurt if a paediatric oral suspension is unavailable.
• Complete the full course — symptomatic improvement comes within 1–2 weeks but stopping early causes relapse.

Hoe het werkt

Griseofulvin binds to fungal microtubules (specifically, β-tubulin) and disrupts mitotic spindle formation. The result is impaired hyphal growth. The drug is incorporated into newly-synthesised keratin in the hair, skin, and nail — meaning protected new growth replaces fungus-infected old keratin as it sheds. This is why long courses are required, especially for nail (which grows slowly).

Bijwerkingen

Geneesmiddelinteracties

Contra-indicaties

• Severe liver disease, porphyria.
• Pregnancy (teratogenic in animals).
• Hypersensitivity to griseofulvin.
• Systemic lupus erythematosus (can precipitate flares).

Zwangerschap & borstvoeding

Griseofulvin is contraindicated in pregnancy. Effective contraception is required during therapy and for 1 month after the last dose (washout period). Men: limited data suggest sperm quality may be temporarily reduced — many guidelines recommend avoiding conception for 6 months after a course in men too, though the evidence base is weaker. Excretion in breast milk is unclear — alternatives are preferred.

Veelgestelde vragen

When is griseofulvin still preferred over terbinafine?

For tinea capitis caused by Microsporum canis (typically picked up from cats / dogs). Terbinafine has 60–70% cure rates for Microsporum versus > 90% for Trichophyton; griseofulvin has 80–90% cure rates for Microsporum. The cause is determined by fungal culture or PCR. Pre-school children with kitten exposure — Microsporum is a common cause.

My child has scalp ringworm — what should I expect?

6–8 weeks of daily oral griseofulvin (or 4 weeks oral terbinafine if Trichophyton). Plus medicated shampoo (selenium sulphide or ketoconazole) twice weekly to reduce shedding to others. Don’t share hairbrushes / hats. School policy: most schools allow attendance once treatment is started.

Why does griseofulvin reduce the contraceptive pill?

Griseofulvin induces hepatic CYP enzymes that metabolise oestrogen and progestogen. Ethinylestradiol levels can fall enough to allow ovulation. Use additional barrier contraception during the course and for 1 month after the last dose. This warning applies to combined pills, mini-pills, contraceptive patch, and vaginal ring; the levonorgestrel IUS and copper IUD are unaffected.

Why a fatty meal?

Griseofulvin is poorly water-soluble. Taken with a high-fat meal (e.g. eggs, full-fat yogurt, peanut butter on toast), bioavailability roughly doubles compared to fasting. For paediatric dosing, mixing the crushed tablet into yogurt or peanut butter is both an absorption strategy and a palatability strategy.

Is Grisovin FP the same as Fulcin / Grisactin?

Yes — Fulcin and Grisactin are older brand names of griseofulvin. Grisovin FP contains the same active ingredient, manufactured by GSK under WHO-GMP. Bioequivalent.

Why am I getting a rash on my arms in the sun?

Griseofulvin is photosensitising. UV exposure during therapy can produce an itchy rash on sun-exposed skin. Use SPF 30+ broad-spectrum sunscreen, long sleeves outdoors, and avoid sunbeds during the course.

Can my child play sport with tinea capitis?

Yes — once treatment is started. Avoid sharing helmets / caps / hairbrushes; wash bedding hot. Most school and sports authorities allow return to activity 24–48 hours after starting oral antifungal.

What if my tinea pedis or onychomycosis hasn’t cleared after 12 weeks of griseofulvin?

Switch to terbinafine or itraconazole — both have higher cure rates for adult-onset dermatophyte nail and skin infections. Recheck the fungal diagnosis with a clipping for microscopy / culture before changing — the original diagnosis may have been wrong.

Is it safe to drink alcohol on griseofulvin?

A rare disulfiram-like reaction (flushing, tachycardia, nausea) has been reported. Most patients tolerate moderate alcohol without issue. Avoid heavy drinking during the course.

Why is the course so long for nails?

Griseofulvin only protects newly-formed keratin — it does not eradicate fungus from existing infected nail. The nail has to grow out from the cuticle. Toenails grow ~1.5 mm per month, so a fully grown-out toenail takes ~9 months. Modern practice prefers terbinafine or itraconazole for nail because they concentrate in the existing nail and shorten the active treatment phase.

Opslag

Store tablets at 15–25 °C, away from light and moisture. Keep out of reach of children. Do not use after expiry.

Andere antischimmelmiddelen die u mogelijk interesseren

If Grisovin FP is unavailable, here are alternatives — same molecule from a different manufacturer, plus first-line modern alternatives where griseofulvin is no longer preferred.

• Zimig (terbinafine 250 mg) — First-line for adult dermatophyte tinea / onychomycosis.
• Sporanox (itraconazole 100 mg) — Onychomycosis pulse therapy alternative.
• Clocip (clotrimazol 1% crème) — Topical for skin tinea + Candida; pregnancy-safe.
• Keto Cream (ketoconazole 2%) — Topical for tinea + seborrhoeic dermatitis.
• Loceryl (amorolfine 5%) — Topical lacquer for mild distal nail infection.

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