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Active Ingredient: Fluconazole
Brand Name: Diflucan

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Fluconazole Drug Recommendation

For a single uncomplicated oropharyngeal Candida infection in a grownup or older baby with signs, select native therapy with miconazole oral gel. Take into account nystatin if the impact is inadequate. In (severely) immunocompromised sufferers, systemic therapy with fluconazole or itraconazole drink is most well-liked. In case of (repeated) relapses, take into account intermittent therapy or upkeep therapy with fluconazole.

For infants with suspected ache, whether or not it is mixed with ache throughout or after maternal feeding, treat thrush with a neighbourhood antifungal. For infants as much as and together with 3 months, select nystatin. For infants 4 months and older, the simpler miconazole is most well-liked, offered it’s utilized appropriately. Deal with the mom’s nipples with miconazole cream to stop reinfection of the kid.

As therapy of troublesome signs of vulvovaginal candidiasis, native and oral antimycotics are equally efficient. Due to the decreased threat of uncomfortable side effects, native therapy with miconazole is most well-liked. Give fluconazole if oral therapy is most well-liked (not in being pregnant or lactation). Deal with relapses as if they had been the primary infection.

Diflucan Indications

Adults

Remedy of:

  • mucosal candidiasis, together with:
    • oropharyngeal candidiasis;
    • esophageal candidiasis;
    • candiduria;
    • persistent oral atrophic candidiasis, if oral hygiene or native therapy is inadequate;
    • persistent mucocutaneous candidiasis;
  • acute or recurrent vaginal candidiasis; when native remedy shouldn’t be applicable;
  • candida balanitis, when native remedy shouldn’t be applicable;
  • invasive candidiasis;
  • dermatomycoses together with:
    • tinea pedis;
    • tinea corporis;
    • tinea cruris;
    • tinea versicolor;
    • different dermal candida infections, when systemic remedy is indicated;
  • tinea unguium (onychomycosis), when different means should not appropriate;
  • coccidioidomycosis;
  • cryptococcal meningitis.

Prophylaxis of:

  • recurrences of oropharyngeal or esophageal candidiasis in sufferers with HIV an infection at excessive threat of relapse;
  • recurrences of vaginal candidiasis at ≥ 4 recurrences per 12 months;
  • candidiasis in case of extended neutropenia;
  • recurrences of cryptococcal meningitis at excessive relapse threat.

Kids

Remedy of:

  • oropharyngeal candidiasis;
  • esophageal candidiasis;
  • invasive candidiasis;
  • cryptococcal meningitis.

Prophylaxis of:

  • candidiasis in case of compromised immune operate;
  • recurrences of cryptococcal meningitis at excessive relapse threat.

What Should You Discuss To Your Doctor Before Using This Medicine

  • Being pregnant
    • Teratogenesis: In depth expertise with single or cumulative doses of ≤ 150 mg doesn’t present a rise within the general threat of malformations. Research have recorded greater than 40,000 exposures to fluconazole within the first trimester. A few of these had been in allotting databases, wherein case it’s not sure whether or not the girl took the drug. The information don’t present an unequivocally elevated threat of start defects. There are research that present a barely elevated threat of particular abnormalities, however the image shouldn’t be constant throughout research. Talked about are congenital coronary heart defects (tetralogy of Fallot, transposition of the nice vessels), schisis and musculoskeletal abnormalities.

      In a single giant observational cohort examine, the marginally elevated threat of musculoskeletal malformations corresponds to about 1 further case per 1000 ladies handled with cumulative doses ≤ 450 mg in comparison with ladies handled with topical azoles, and about 4 further instances per 1000 ladies handled with doses > 450 mg. A barely elevated threat of miscarriage can’t be excluded primarily based on present research. There are a selection of case stories describing a number of start defects (e.g. brachycephaly, ear dysplasia, big anterior fonticulus, curved femur, radio-humeral synostosis) after long-term use (≥ 3 months) of fluconazole in excessive doses (400-800 mg/day), in reference to disseminated infections (e.g. coccidioidomycosis).

    • Recommendation: The one dose administration of 150 mg can be utilized. Extended use or use of upper doses (> 150 mg) shouldn’t be really useful, restrict utility to life-threatening infections.

  • Lactation
    • Transition in breast milk: Sure, in appreciable amount. The typical focus is about 98% of that within the mom’s plasma. The height focus happens after roughly 5.2 hours. The estimated dose of fluconazole ingested by the kid after a single dose is already greater than 15%. The lengthy elimination half-life is a priority. No antagonistic results on the toddler have been described as but.
    • Suggestion: Lactation might be continued after a single dose of fluconazole (≤ 200 mg). Quick-term use over a number of weeks (100-200 mg for 2-3 weeks) might be thought of; that is in all probability protected. In observe, fluconazole is often utilized in these quantities. Lengthy-term use shouldn’t be really useful (attributable to comparatively little documentation).

  • Contraindications
    • hypersensitivity to azole compounds.

Fluconazole Drug Interaction

Concomitant use of fluconazole and QT-prolonging medicinal merchandise metabolised by CYP3A4 (equivalent to erythromycin, pimozide, and quinidine) is contraindicated.

Use warning when combining with amiodarone attributable to elevated threat of QT prolongation, particularly with excessive doses of fluconazole (800 mg).

Fluconazole is a reasonably robust inhibitor of CYP2C9 and CYP3A4 and likewise a (very) robust inhibitor of CYP2C19; it in all probability additionally inhibits P-glycoprotein (Pgp). Watch out for elevated plasma concentrations of medicine that can be largely metabolised by these enzyme methods (e.g., tofacitinib, which is metabolised by each CYP3A4 and CYP2C19; scale back its dose to 5 mg/day). Because of the lengthy terminal half-life of fluconazole, the enzyme inhibitory impact persists for 4-5 days after discontinuation of fluconazole.

Additionally watch out with the mix of medicinal merchandise which can be largely metabolised by CYP2C9 equivalent to:

  • sulphonylurea derivatives
  • some NSAIDs
    • naproxen
    • diclofenac
    • celecoxib
    • meloxicam
    • dose adjustment could also be required
  • phenytoin.

The identical applies to fluvastatin; discontinue if creatine kinase is elevated or if rabdomyolysis or myopathy is identified or suspected.

Fluconazole:

  • will increase the publicity to voriconazole; because of the lengthy half-life, test for uncomfortable side effects of voriconazole if voriconazole is given consecutively to fluconazole;
  • might improve the impact of vitamin Okay antagonists; moreover test the INR;
  • will increase plasma ranges of amitriptyline, nortriptyline, theophylline and zidovudine by way of numerous mechanisms;
  • will increase publicity to rifabutin with elevated threat of uveitis.

Rifampicin reduces publicity (by roughly 25%) to fluconazole; the next dose could also be required. Hydrochlorothiazide can probably improve the plasma concentration of fluconazole by roughly 40%. Mixed therapy with cyclophosphamide and fluconazole results in a rise in serum bilirubin and creatinine. A case of pseudotumor cerebri has been reported with tretinoin.

Fluconazole Dosage

No dose adjustment is required when switching from parenteral to oral type of administration (or vice versa).

Kids have the next clearance of fluconazole than adults. A dose of 100, 200 and 400 mg in adults corresponds to a dose of three, 6 and 12 mg/kg physique weight in youngsters. In adolescents (12-17 years of age), the dosage for adults or youngsters needs to be used based on weight and pubertal growth, on the discretion of the physician. Don’t exceed the utmost day by day dose of 400 mg in youngsters.

  1. Remedy oropharyngeal candidiasis
    • Adults
      • Oral, intravenous:
        • Based on the producer, loading dose of 200-400 mg on day 1, adopted by 100-200 mg 1×/day.
        • Period of therapy: 7-21 days (till the oropharyngeal candidiasis is in remission), longer if obligatory in sufferers with a severely compromised immune response. For dosage and period of therapy.
    • Kids
      • Oral, intravenous:
        • Kids from 28 days to 11 years: loading dose of 6 mg/kg physique weight on day 1, adopted by 3 mg/kg 1×/day; therapy period 7-21 days, longer if obligatory in sufferers with a severely impaired immune response; most 400 mg/day.
        • Pregnant neonates aged 15-27 days: identical dosage each 48 hours, max. 12 mg/kg each 48 hours.
        • Pregnant newborns 0-14 days: identical dosage each 72 hours, max. 12 mg/kg each 72 hours.

  2. Remedy of esophageal candidiasis
    • Adults
      • Oral, intravenous:
        • Based on the producer, loading dose of 200-400 mg on day 1, adopted by 100-200 mg 1×/day.
        • Period of therapy: 14-30 days (till the esophageal candidiasis is in remission), longer if obligatory in sufferers with a severely compromised immune response.
    • Kids
      • Oral, intravenous:
        • Kids from 28 days to 11 years: loading dose: 6 mg/kg physique weight (day 1), adopted by 3 mg/kg 1×/day.
        • Period of therapy: for 14-30 days, longer if obligatory in sufferers with severely impaired immune response; most 400 mg/day.
        • Gestational age of neonates 15-27 days: identical dosage each 48 hours, max. 12 mg/kg each 48 hours.
        • Pregnant newborns 0-14 days: identical dosage each 72 hours, max. 12 mg/kg each 72 hours.

  3. Remedy candiduria
    • Adults
      • Oral, intravenous:
        • Based on the producer 200-400 mg 1×/day.
        • Period of therapy: 7-21 days, longer if obligatory in sufferers with a severely compromised immune response. 

  4. Remedy of persistent atrophic candidiasis
    • Adults
      • Oral, intravenous: 50 mg 1×/day; therapy period 14 days.

  5. Remedy of persistent mucocutaneous candidiasis
    • Adults
      • Oral, intravenous: 50-100 mg 1×/day. Remedy period: as much as 28 days, longer intervals relying on severity of an infection and underlying immunosuppression.

  6. Remedy of acute candidiasis vaginalis and Candida balanitis
    • Adults (and adolescents)
      • Oral: 150 mg as soon as solely. Efficacy and security in youngsters haven’t been established for this indication. If therapy of adolescents (12-17 years) is critical, use the identical dose as adults.

  7. Remedy of invasive candidiasis
    • Adults
      • Oral, intravenous: loading dose of 800 mg on day 1, adopted by 400 mg 1×/day.
      • Period of therapy: for candidaemia based on the producer as much as 2 weeks after the first unfavorable blood tradition outcome and the disappearance of signs.
      • Based on SWAB, the period of therapy for candidaemia with out proof of disseminated candidiasis is as much as 2 weeks after the final optimistic blood tradition; for acute disseminated candidiasis, no less than 4-8 weeks.
    • Kids
      • Oral, intravenous: Based on the producer, for kids aged 28 days to 11 years: 6-12 mg/kg physique weight 1×/day (most 400 mg/day); the period of therapy depends upon the severity of the sickness.
      • Pregnant newborns from 15-27 days: identical dosage each 48 hours, max. 12 mg/kg each 48 hours.
      • Pregnant newborns 0-14 days: identical dosage each 72 hours, max. 12 mg/kg each 72 hours. For dosage and frequency of administration.

  8. Remedy of tinea pedis, tinea corporis, tinea cruris and dermal Candida infections (aside from tinea versicolor, see under)
    • Adults
      • Oral: 150 mg 1×/week or 50 mg 1×/day. Remedy period: 2-4 weeks, for tinea pedis 6 weeks if obligatory.

  9. Remedy tinea versicolor
    • Adults
      • Oral: 300-400 mg 1×/week for 1-3 weeks or 50 mg 1×/day for 2-4 weeks.

  10. Remedy of tinea unguium
    • Adults
      • Oral: 150 mg 1×/week. Remedy period: proceed therapy till the contaminated nail is changed, often 3-6 months for fingernails and 6-12 months for toenails. Nevertheless, the speed of progress can differ tremendously relying on the particular person and age. Even after profitable therapy of long-term, persistent infections, nails can generally stay misshapen.

  11. Remedy coccidioidomycosis
    • Adults
      • Oral, intravenous: 200-400 mg 1×/day, in some infections (particularly for meningitis) 800 mg/day needs to be thought of.
      • Period of therapy: 11-24 months, longer if obligatory.

  12. Remedy of cryptococcal meningitis
    • Adults
      • Oral, intravenous: Based on the producer: loading dose of 400 mg on day 1, adopted by 200-400 mg 1×/day, in case of life-threatening an infection improve the day by day dose to 800 mg/day.
      • Remedy period: often no less than 6-8 weeks.Kids
      • Oral, intravenous: Kids from 28 days to 11 years: 6-12 mg/kg physique weight 1×/day (max. 400 mg/day); the period of therapy depends upon the severity of the sickness.
      • Pregnant newborns from 15-27 days: identical dosage each 48 hours, max. 12 mg/kg each 48 hours.
      • Pregnant newborns 0-14 days: identical dosage each 72 hours, max. 12 mg/kg each 72 hours.

  13. Prophylaxis of recurrent oropharyngeal and esophageal candidiasis
    • Adults
      • Oral, intravenous: 100-200 mg 1×/day or 200 mg 3×/week, for an indefinite interval for sufferers with persistent immunosuppression.

  14. Prophylaxis of recurrent vaginal candidiasis (≥ 4 episodes per 12 months)
    • Adults
      • Oral: 150 mg on days 1, 4 and seven, adopted by a upkeep dose of 150 mg 1×/week for six months. Efficacy and security in youngsters haven’t been established for this indication. If therapy in adolescents (12-17 years) is critical, use the identical dosage as in adults.

  15. Prophylaxis of Candida infections in extended neutropenia
    • Adults
      • Oral, intravenous: 200-400 mg 1×/day. Begin therapy just a few days earlier than the anticipated onset of neutropenia and proceed till 7 days after restoration from neutropenia (depend > 1.0 × 10 cells/litre).9
    • Kids
      • Oral, intravenous: Kids aged 28 days to 11 years: 3-12 mg/kg physique weight 1×/day (max. 400 mg/day), relying on the extent and period of the induced neutropenia (see grownup dosage).
      • Pregnant neonates aged 15-27 days: identical dosage each 48 hours, max. 12 mg/kg each 48 hours.
      • Pregnant neonates aged 0-14 days: identical dosage each 72 hours, max. 12 mg/kg each 72 hours.

  16. Prophylaxis of a recurrence of cryptococcal meningitis
    • Adults
      • Oral, intravenous: (After a full course of therapy with the complete dose): 200 mg 1×/day, for an indefinite interval. For period of secondary prophylaxis in HIV.
    • Kids
      • Oral, intravenous: (After a full course of therapy with the complete dose): Kids from 28 days to 11 years: 6 mg/kg physique weight 1×/day (max. 400 mg/day), indefinitely.
      • Pregnant newborns from 15-27 days: identical dosage each 48 hours, max. 12 mg/kg each 48 hours.
      • Pregnant newborns from 0-14 days: identical dosage each 72 hours, max. 12 mg/kg each 72 hours.

  17. Diminished renal operate
    • For a single dose, no dose adjustment is critical;
    • For a course of therapy, use the traditional loading dose (applicable to the indication) and modify the following dose accordingly:
      • Creatinine clearance > 50 ml/min: no dose adjustment required;
      • Creatinine clearance ≤ 50 ml/min (no haemodialysis): 50% of the really useful dose;
      • On haemodialysis: 100% of the really useful dose after every haemodialysis and on days when no dialysis is going down give a decrease dose on the premise of the (calculated/estimated steady-state) creatinine clearance.
    • Decreased hepatic operate: comparatively few knowledge can be found on utility; administer with warning.

Proper Usage of Fluconazole

  • Administer by i.v. infusion (max. 20 mg/min = max. 10 ml/min) or orally, relying on the scientific state.
  • Administer the oral day by day dose without delay.
  • Take the capsules complete with some water.
  • Shake the suspension earlier than use.

Diflucan Side Effects

  • headache
  • Nausea, vomiting, diarrhoea, stomach ache
  • Pores and skin rash
  • Elevated values of alkaline phosphatase
  • dizziness, convulsions, paraesthesia, style dysfunction.
  • Decreased urge for food
  • Dry mouth, dyspepsia, flatulence, constipation
  • Cholestasis, jaundice, elevated bilirubin
  • Anaemia
  • Drowsiness, insomnia, fatigue, asthenia, malaise, fever
  • Muscular ache
  • Itching
  • urticaria
  • mounted drug eruption
  • elevated perspiration
  • Exfoliative pores and skin problems equivalent to:
    • Stevens-Johnson syndrome and poisonous epidermal necrolysis
    • exfoliative dermatitis
    • acute generalised exanthematous pustulosis (AGEP)
    • angioedema
    • facial oedema
    • alopecia
  • Tremo
  • Hepatitis
  • hepatocellular harm or necrosis
  • liver failure
  • QT prolongation

Disclaimer

Information concerning psychotic disorders, included within the review of Fluconazole, is used for the informative features exclusively as well as should not be thought-about to alternative to licensed healthcare or referral of the well being treatment distributor.

 

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Frequently asked questions

  1. What is Fluconazole Diflucan?

    Diflucan is an anti-fungal antibiotic which used to treat fungal infections called candidiasis. This medication is prescribed for treatment such type of infections as vaginal, throat and fungal infections, infections of the urinary tract, peritonitis, and pneumonia. 

  2. What to do if you miss a dose?

    If you miss a dose of Fluconazole, take it as quickly as potential. However, whether it is virtually time to your subsequent dose, skip the missed dose and return to your common dosing schedule. Do not double doses.

  3. What if u take too much Diflucan?

    If an overdose happens, name your physician or call your nearest hospital. You might have pressing medical care. You might also contact the poison management at your local hospital.

  4. How to store Fluconazole?

    Store at room temperature 15-30 C (59-86 F) away from moisture and heat.

  5. What Should I Avoid While Taking Fluconazole?

    Avoid consuming alcohol or utilizing unlawful medicine when you are taking Diflucan. They might lower the advantages (e.g. worsen your confusion) and improve hostile results (e.g. sedation) of the remedy.

  6. What are the side effects of Fluconazole Diflucan?

    The most common side effects include an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. 

  7. What are the Contraindication?

    Diflucan is not allowed to people which are hypersensitivity to Fluconazole or other antifungal azole preparations, eg clotrimazole, ketoconazole, itraconazole and other. 


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