Which antifungal agent is contraindicated in renal failure?

Amphotericin B is contraindicated in renal failure primarily due to its potential nephrotoxicity. This antifungal agent is known to cause kidney damage, which can be exacerbated in patients with existing renal impairment. When amphotericin B is administered, it can lead to a reduction in renal blood flow and glomerular filtration rate, thereby worsening renal function. Consequently, it is necessary to take additional care or avoid its use in patients who already have compromised kidney function to prevent further deterioration of their condition.

In contrast, other antifungal agents like griseofulvin, clotrimazole, and nystatin may not carry the same level of risk for renal toxicity, making them safer alternatives for patients with renal impairment. Griseofulvin, for example, is primarily metabolized by the liver, and while it may require caution and monitoring, it is not predominantly contraindicated in renal failure. Clotrimazole and nystatin are topically applied or poorly absorbed systemically, further reducing any systemic renal impact they may have. This distinction is essential for clinicians when prescribing antifungal therapy to patients with renal issues.