The azole antifungal agents have expanded the armamentarium of agents useful in the treatment of systemic fungal infections. Clotrimazole, an early imidazole antifungal, proved was found to rapidly induce its own metabolism after oral or intravenous administration. Its use is now confined to topical therapy. Miconazole is toxic and its availability is only as an intravenous formulation. Ketoconazole, the first oral imidazole, has proved useful for a wide variety of fungal infections. This chapter focuses on the use of these four azole agents that have proved beneficial in treating systemic fungal infections. The imidazole compounds contain a five member azole ring with two nitrogen atoms. The triazoles have a third nitrogen atom added. The triazole ring increases tissue penetration, prolongs half-life, and enhances efficacy of the azoles while decreasing the toxicity when compared with imidazole antifungal agents. Azoles inhibit the biosynthesis of ergosterol, a component of fungal cell membranes, via inhibition of the cytochromes P450-dependent enzyme lanosterol14-α-demethylase.Lanosterol14-α-demethylase is necessary for the conversion of lanosterol to ergosterol. Depletion of ergosterol in the fungal cell membrane results in altered membrane fluidity, thereby reducing the activity of membrane-associated enzymes. This leads to increased permeability and subsequent inhibition of cell growth and replication. The binding efficiency of azole antifungal agents to cytochromes P450 differs, resulting in differences in antifungal activity, toxicity of the agents, and the drug interactions with other cytochrome P45O-metabolized drugs. The chapter details the antifungal activity of the azoles, their pharmacology, clinical use, side effects, and administration. Drug interactions with azole antifungals are of two categories—decreases in azole bioavailability because of chelation or secondary to increases in gastric pH; and interactions with other cytochrome P45O-metabolized drugs. Drug interactions in the second category may result in increases or decreases in the azole antifungal, in the interacting drug, or in both drugs.