Antifungals Interactions

Saccharomyces boulardii is a live yeast probiotic that is killed by systemic antifungals such as fluconazole, itraconazole, amphotericin B, and the echinocandins, so taking the two together cancels any probiotic benefit. More importantly, S. boulardii has caused documented bloodstream infections (fungemia), particularly in critically ill, immunocompromised, and catheterized patients, and those same antifungals are the drugs used to treat it.

Systemic antifungals (such as fluconazole, itraconazole, amphotericin B, and the echinocandins) can kill yeast-based probiotics such as Saccharomyces boulardii, blunting their benefit. Bacterial probiotics like Lactobacillus and Bifidobacterium are generally unaffected, because their cell structure differs from fungi.