Fluconazole - Uses, Dosage, Side Effects, Drug Warnings, and Precautions.

Overview:

Fluconazole is a prescription antifungal medication used to treat fungal or yeast infections. It is available as capsules, tablets, suspension form (liquid), and an injection (to be administered by a healthcare professional only). Fluconazole helps reduce infections by preventing the growth of infection-causing fungus in the body, especially those caused by the Candida species. Do not take this drug if there is a previous history of allergy or hypersensitivity to Fluconazole or any other components of the medication. In case of skin rash or yellowing of skin or white eyes, report to the doctor immediately. Avoid activities requiring mental alertness while taking this medication, as it may cause drowsiness or seizures.

Drug Group:

Fluconazole belongs to the class of triazole antifungal agents. It acts by inhibiting sterol synthesis in the fungus. This further leads to steps resulting in the prevention of growth of the infection-causing fungi without destroying them. The other drugs in the triazole class include Itraconazole, Voriconazole, and Posaconazole.

What Is Fluconazole Used For?

• Fluconazole is a widely used antifungal agent to treat a variety of fungal and yeast infections in areas prone to fungal growth, like the throat, food pipe, vagina, throat, etc.

• It is particularly used in conditions like vaginal candidiasis (a fungal infection that occurs in the vagina), peritonitis (inflammation of the peritoneal cavity; a membrane covering the abdominal walls and organs), oropharyngeal and esophageal candidiasis (fungal infection caused by Candida in the food pharynx and food pipe), and systemic Candida infections (Candida infection in the blood), and pneumonia (inflammation of the air sacs of the lungs).

• It is also used to treat and prevent yeast infections in patients with an increased probability of getting infected due to radiation therapy or chemotherapy before a bone marrow transplant (replacement of unhealthy bone marrow with healthy one).

• Fluconazole is also often used to treat fungal meningitis (infection of the spine and brain membranes).

How Does Fluconazole Work?

Fluconazole acts by inhibiting sterol synthesis in the fungus. When sterol production is prevented, a compound called the 14-methyl sterols will accumulate in the fungi. This buildup inhibits the growth of infection-causing fungus and thereby helps treat the infection. Fluconazole is used to treat mainly infections caused by the fungus Candida which can affect the mouth, throat, food pipe, vagina, blood, lungs, abdomen, and other internal organs.

Onset of Action:

90 % of Fluconazole orally taken reaches the blood circulation. It reaches its maximum concentration in the blood within one to two hours following administration. It is primarily eliminated through urine. In short, the onset of action for Fluconazole is between one to two hours following oral intake, and its activity usually lasts for approximately 30 hours (20 to 50 hours) in adults.

Habit-Forming:

Fluconazole has not been reported to show any habit-forming tendencies in people taking the drug.

Expiry Date:

Avoid taking this medicine after it expires. The expiry date will be provided on the back of the packet.

What Is the Dosage of Fluconazole?

Fluconazole is available in the following dosage forms and doses:

• Oral Tablet: 50 mg, 100 mg, 150 mg, 200 mg.

• IV Solution (Injection): 200 mg/100 ml, 400 mg/200 ml, 100 mg/50 ml.

• Liquid Suspension: 200 mg/100 ml, 400 mg/200 ml, 100 mg/50 ml.

Multiple dosing is required for Fluconazole while treating fungal infection except for in case of vaginal candidiasis. The adjustment in the dose is based on the response to the treatment provided. Make sure to consult the doctor periodically to assess the treatment progress until the infection is completely cured.

The recommended dosage of Fluconazole for various conditions is listed below:

• Vaginal Candidiasis: 150 mg as a single oral dose.

• Oropharyngeal and Esophageal Candidiasis: The doctor may start with an initial dose of 200 mg on the first day, followed by 100 mg once daily.

• Candida Peritonitis: 200 mg initially on the first day, followed by 50 to 200 mg once daily.

• Urinary Tract Infections: 200 mg initially on the first day, followed by 50 to 200 mg once daily.

• Candida Infections in Blood: Up to 400 mg daily.

• Prevention of Fungal Infections (Candidiasis ) In Patients Undergoing Bone-Marrow Transplantation: Up to 400 mg /day.

As indicated, the dose will be adjusted by the doctor for children and patients with kidney or liver conditions.

How to Use Fluconazole?

Fluconazole is commonly available in tablet form or liquid (suspension) for oral intake.

• It is usually taken once daily with or without food.

• The duration of the therapy will be based on the kind and severity of the infection.

• Enquire the physician or pharmacist to explain instructions on the prescription label that is not understood and carefully follow them. Fluconazole should be used as prescribed. Never take it in more significant or fewer amounts or more frequently than directed by the doctor.

• As the therapy starts (the first day), the doctor might advise taking two doses of Fluconazole. Pay close attention to these instructions.

• Before each usage, give the liquid a good shake to evenly distribute the medication.

• During the first few days of Fluconazole therapy, the response to the medication may be seen. Alert the healthcare provider if the symptoms do not disappear or worsen.

• Even if symptoms reside, keep taking Fluconazole until the doctor instructs.

Missed Dose:

While taking Fluconazole, and if a dose is missed, take it as soon as it is remembered. But if the time for the next dose is near, do not take two tablets together, as it might result in severe adverse reactions. Just skip the missed dose and take the next dosage.

Overdose:

In case of overdosing on the medication, contact the emergency department or the nearest poison control center immediately.

What Are the Contraindications of Fluconazole?

Do not use Fluconazole in the following conditions:

• A known allergy to the medication or any of its components.

• Already in therapy with drugs like Pimozide, Erythromycin, or Quinidine.

What Are the Drug Warnings and Precautions?

Inform the physician if any of the following conditions are present before taking Fluconazole:

1. Allergy: History of allergy to Fluconazole or any other medications belonging to the azole class.

2. Pregnancy and Breastfeeding: Fluconazole may harm the fetus if administered during pregnancy. Therefore, inform the physician in the first three months of the pregnancy intend to get pregnant, or are breastfeeding. During therapy and one week following the last dose, the doctor might advise taking birth control to avoid getting pregnant.

3. Heart Diseases: Inform the doctor if there is a history of heart disease, significantly in conditions of altered heartbeat or low potassium levels. This is because Fluconazole is associated with changes in heartbeat. Hence, prior care should be taken before administering the medication.

4. Skin Rashes: If any rashes are developed on the skin after taking this medicine, report them immediately to the doctor.

5. Surgery: Inform the doctor of Fluconazole administration before any surgical procedures, including dental surgeries.

6. Endocrine Problems: Fluconazole is associated with changes in the hormone levels produced by the adrenal glands. This is reversible, and the levels return to normal once the drug is discontinued.

What Are the Side Effects of Fluconazole?

Fluconazole administration is associated with drowsiness as its most common side effect, along with the following:

• Headache.

• Diarrhea.

• Nausea or a stomachache.

• Vomiting.

• People with decreased immunity develop a severe rash.

The serious side effects include

Liver Injury: In case of liver damage, the following symptoms may be observed

• Yellowing of the skin or the whites of the eyes.

• Itchy skin.

• Nausea or vomiting.

Pointed Torsions: (a life-threatening heartbeat condition).

Symptoms include

• Rapid, erratic heartbeat.

• Dizziness and fainting.

• Seizures.

Severe Rash: In cancer patients or those with acquired immune deficiency syndrome (AIDS). The symptoms include

• Peeling of skin.

• Development of extreme rashes.

Endocrine Problems: Problems with the adrenal gland. Among the symptoms is

• Tiredness.

• Muscular tremor.

• Abdominal pain.

• Loss of appetite.

If these side effects are minor, they can disappear in a few days or weeks. Consult the doctor or pharmacist if they are more severe or persistent.

What Are the Interactions of Fluconazole?

All medications naturally interact with other medications, food, and supplements. The common interactions of Fluconazole are listed below:

1. With Other Drugs:

• Alprazolam.
• Acenocoumarol.
• Amisulpride.
• Amitriptyline.
• Azithromycin.
• Carbamazepine.
• Carvedilol.
• Chloroquine.
• Chlorpromazine.
• Ciprofloxacin.
• Clofazimine.
• Clopidogrel.
• Cobimetinib.
• Codeine.
• Colchicine.
• Cyclosporine.
• Daridorexant.
• Deflazacort.
• Desipramine.
• Deslorelin.
• Dicumarol.
• Doxorubicin.
• Efavirenz.
• Ergotamine.
• Famotidine.
• Felbamate.
• Fentanyl.
• Formoterol.
• Fosaprepitant.
• Foscarnet.
• Galantamine.
• Gemifloxacin.
• Gonadorelin.
• Goserelin.
• Halothane.
• Histrelin.
• Hydrocodone.
• Hydroquinone.
• Hydroxychloroquine.
• Moxifloxacin.
• Nitrofurantoin.
• Norfloxacin.
• Nortriptyline.
• Octreotide.
• Ofloxacin.
• Olanzapine.
• Parecoxib.
• Paroxetine.
• Sotalol.
• Temsirolimus.
• Theophylline.
• Tolvaptan.
• Torsemide.
• Venlafaxine.
• Vinblastine.
• Vincristine.
• Zuclopenthixol.

These are some of the drugs that have major interaction with Fluconazole. Since the information does not cover all the drugs, refer to the doctor or pharmacist before starting the medication.

2. With Alcohol: Fluconazole does not interact with alcohol. However, concomitant intake of alcohol may increase the incidence of side effects like nausea, vomiting, or abdominal pain. Drinking in moderation is preferred while on Fluconazole therapy.

3. With Food: Caffeine-containing food and beverages: Taking Fluconazole with caffeine-containing food or beverages may cause drowsiness, nausea, or vomiting.

4. With Disease:

• Heart Disease: Inform the doctor of a history of alterations in a heartbeat or if the potassium levels are low.
• Kidney Disease: Dose adjustment is required in case of kidney diseases. Hence, inform the healthcare provider before starting with Fluconazole therapy.
• Dialysis: In the case of patients under dialysis, Fluconazole is administered post the dialysis procedure.

What Are the Common Brand Names or Trade Names of Fluconazole?

The common brands of Fluconazole available in the market are

• Capsule Diflucan 150 mg.

• Tablet Fluka 150 mg.

• Tablet Zocon 150 mg.

• Tablet Forcan 200 mg.

• Tablet Candi 200 mg.

• Capsule Fluziwell 200 mg.

• Tablet Funzol 150 mg.