Fluconazole (oral)

Overview

Most often used to treat significant fungal (nail fungal) and yeast infections, Fluconazole is available in oral form with a physician's prescription. This medication may also be given to patients who have had a bone marrow transplant or who have received radiation treatment for cancer.

Fluconazole may be used to treat vaginal yeast infections (candidiasis), esophageal yeast infections (candida esophagitis) or oral thrush (oropharyngeal candidiasis), along with candida infections located in other parts of the body. It is also used to prevent cryptococcal meningitis, a fungal infection of the brain and spinal cord that can rapidly spread to other parts of the body, in patients with a compromised immune system. This medication both kills and prevents the growth of fungus or yeast. In some cases, Fluconazole is prescribed in a single dose to treat vaginal yeast infections.

This medication differs from some other antifungal drugs because it is indicated for oral, rather than topical use. In comparison to topical antifungal medications, Fluconazole is safer and more easily absorbed through the digestive system.

This medication is available in generic and brand named forms. Fluconazole can be dangerous to an unborn child if used during the first trimester of pregnancy.

Conditions Treated

Type Of Medicine

  • Azole antifungal

Side Effects

Side effects have been known to occur with the use of oral Fluconazole. The most common side effects experienced with Fluconazole include diarrhea, rash, vomiting and increased levels of liver enzymes. The side effects listed below are rare and if any occur, immediate medical attention should be sought.

  • Abdominal pain
  • Appetite loss
  • Dark Colored Urine
  • Diarrhea
  • Dizziness
  • Elevated heartbeat
  • Fever or chills
  • Headache
  • Hives, itching or rash
  • Light colored stools
  • Nausea or vomiting
  • Swelling of the eyelids, face, lips or tongue
  • Tightness in the chest
  • Unusual fatigue or weakness
  • Vomiting blood
  • Yellow eyes or skin

This medication may cause serious liver disease, in rare cases. The patient should seek immediate medical attention if any of the signs of liver disease develop, such as severe stomach or abdominal pain, nausea and vomiting, yellowing of the eyes and skin, dark colored urine or extreme fatigue.

Dosage

As with any medication, Fluconazole should only be used by the person it is prescribed to. This medication is available in tablet or capsule form, as well as in powder form for suspension. A patient information guide is provided along with Fluconazole.

This medication should be taken by mouth with or without food. It is usually taken once daily. The liquid suspension form of Fluconazole should be shaken well before each use and the dose measured carefully using a medication measuring device. A household spoon should not be used to administer this medication, to ensure that the correct dose is given.

Dosage is determined based on the condition being treated as well as response to treatment. In children, weight is also used to determine dosage. Children are generally not prescribed more than 600 mg per day.

Fluconazole works best when the medication amount contained in the body is kept at a consistent level, so it should be taken at or around the same time each day, as directed by the prescribing physician. This medication should be taken until finished, even if symptoms disappear before treatment is complete. If Fluconazole is stopped early, it can allow the fungus to continue to grow, causing an infection to return.

Fluconazole is absorbed rapidly and completely. This medication reaches its peak within one to two hours after being taken orally. Signs of infection may take longer to disappear. Single-dose therapy may be sufficient for treating some vaginal yeast infections.

The amount of this medication prescribed depends on the strength, along with the number of doses taken per day and the length of time it is taken.

For cryptococcal meningitis, adults are generally prescribed 400 mg for the first day, and then 200 mg per day for 10-12 weeks. Children aged 6 months to 13 years are generally prescribed 12 mg per kilogram of body weight for day one, followed by 6 mg per kilogram of body weight, per day, for 10-12 weeks.

For esophageal candidiasis or oropharyngeal candidiasis, adults are typically prescribed 200 mg on day one, followed by 100 mg per day for 2 weeks or longer. Children aged 6 months to 13 years are usually prescribed 6 mg per kilogram of body weight for day one, followed by 3 mg per kilogram of body weight, once per day for 3 weeks or longer.

For infections in other parts of the body, adults are generally prescribed 400 mg per day and children are generally prescribed 6-12 mg per day, based on body weight.

Included below are common dosage amounts for additional conditions treated by Fluconazole.

  • 50-200 mg per day for urinary tract infections for adults
  • 150 mg as a single dose for vaginal candidiasis in adults
  • 400 mg once per day for prevention of candidiasis in adults receiving a bone marrow transplant
  • As determined by the prescribing physician for children with any of the conditions listed above.

If a dose of this medication is missed, it should be taken as soon as possible, unless it is almost time for the next dose. If it is almost time for the next dose, the regular dosing schedule should be resumed. Double doses of this medication should not be taken. This medication should not be stopped or started without the consent of the prescribing physician.

Symptoms of Fluconazole overdose may include confusion and unusual behavior or thoughts. Immediate medical attention should be sought in cases of overdose or suspected overdose.

While taking this medication, certain laboratory or medical tests, such as liver function tests should be performed in order to monitor the progress of treatment and to check for possible side effects.

Patients generally start feeling better no later than two days after starting this medication. If the condition does not improve, the dosage of Fluconazole may be changed or treatment with the medication may be stopped.

Major Drug Interactions

Taking another drug, herb or nutritional supplement, whether over the counter or prescription, along with Fluconazole could lead to adverse effects or change the way that this medication works. A comprehensive list of any medications, herbs or nutritional supplements taken should be shared with the prescribing doctor.

Fluconazole is known to directly interact with clopidogrel.

Serious drug interactions have been documented for Fluconazole with at least 84 different medications. Moderate interactions have been documented with no less than 186 different medications. Questions regarding drug interaction with Fluconazole should be discussed with the prescribing doctor.

It is particularly important for patients taking the following medications to discuss their use with the prescribing physician before taking Fluconazole.

  • Antidepressant medications
  • Blood thinners such as Coumadin or Warfarin
  • Certain cholesterol lowering medications
  • Heart or blood pressure medications
  • Fentanyl
  • Clopidogrel
  • Cyclosporine
  • Oral steroids, including Prednisone
  • Methadone
  • Saquinavir
  • Theophylline
  • Sedatives
  • Seizure medications
  • Non-Steroidal anti-inflammatory drugs (NSAIDs)
  • Oral diabetes medications

Certain medications may affect the heart rhythm when used with Fluconazole, including, but not limited to macrolide antibiotics, pimozide and quinidine.

Fluconazole may slow down the metabolizing of certain medications, which can affect how they work. These medications include asunaprevir and cisapride.

Patients should inform their physician if they use alcohol, tobacco products or marijuana.

Food does not affect the absorption of Fluconazole and this medication can be taken with or without food. There is no need to alter the normal diet of a patient taking Fluconazole.

Warnings

Fluconazole should only be used if a prescription from a physician has been obtained. It should only be taken for the infection for which it is prescribed, unless directed otherwise by the physician. If another infection develops, it may be necessary to take another medication.

Specific medical and laboratory tests should be performed throughout treatment with Fluconazole. Since this medication could interact with other medications, blood work may be required during the course of treatment. All appointments for blood work should be kept and results interpreted by a physician.

Before taking Fluconazole, the prescribing physician and/or pharmacist should be informed of any other drugs, herbs or nutritional supplements being taken, either prescription or non-prescription. It is particularly important to inform the prescribing physician if other antifungal drugs are being taken.

Certain inactive ingredients contained in this medication can cause allergic reactions, so the prescribing physician and/or pharmacist should be informed of any allergies.

Patients with a history of liver disease or kidney disease should inform the prescribing physician before taking this medication. Signs of a liver problem include dark colored urine, unusual fatigue, loss of appetite, light colored stools, stomach pain and yellow skin or eyes.

A certain condition that affects the heart rhythm called QT prolongation can be caused by Fluconazole. This condition is rarely serious, but certain symptoms associated with it may require immediate medical attention.

The existence of specific medical conditions can increase the risk of developing QT prolongation while using Fluconazole. Patients with heart problems or a family history of heart problems should inform the prescribing physician. The QT prolongation risk may also be increased in patients who take diuretics (water pills) or who have conditions which cause sweating, vomiting or diarrhea. The prescribing physician may order certain medical tests, such as an EKG, prior to prescribing Fluconazole.

If a patient experiences a fast heartbeat, or one that does not feel normal or passes out, immediate medical attention should be sought.

Because this medication can cause dizziness, care should be taken to assess side effects before driving or the use of machinery that requires focus to operate. Using alcohol or marijuana can increase dizziness when taking Fluconazole. Alcoholic beverages should be limited while taking this medication.

Rare reports of anemia and acute renal failure have been reported in adults over the age of 60 taking this medication.

Geriatric patients may experience more intense side effects when taking this medication.

Women who are pregnant, or planning to become pregnant should inform the prescribing physician before taking this medication. Birth control pills and other methods of birth control that are hormone based may not work as well when this medication is being taken. An alternate form of birth control should be used while taking Fluconazole.

Pregnant women should only take Fluconazole after it is deemed necessary by the patient and physician. This medication can lead to birth defects in unborn children, particularly if it is taken in high doses during the first trimester of pregnancy. Incidences of spontaneous abortion (com/health/miscarriage/">miscarriage) have also been documented with the use of Fluconazole during the first trimester. Topical treatment of vaginal yeast infections should be considered before taking Fluconazole. The benefits and risks of taking Fluconazole while pregnant may be discussed with the prescribing physician.

Though Fluconazole is passed through breast milk in minimal amounts, it is unlikely to cause harm to a nursing infant. The prescribing physician should be notified if the patient is breastfeeding. The pros and cons of taking this medication while nursing should be discussed with the prescribing physician.

This medication should not be taken along with other antifungal medications, unless indicated by a physician. Patients who have ever taken Fluconazole in the past should inform the prescribing physician before taking it again, whether or not the first treatment was successful.

Certain rare hereditary problems can affect the use of this medication. Patients with fructose or galactose intolerance or any other inherited condition should inform the prescribing physician before taking Fluconazole.

Patients who are lactose intolerant, or who have difficulty digesting sugars or dairy products should use Fluconazole with caution. In capsule form, Fluconazole contains lactose and in liquid form, Fluconazole contains sucrose. In instances where hereditary digestion issues exist, a different form of this medication may be prescribed.

Patients with kidney disease may experience slower removal of Fluconazole from the body. This may increase side effects.

Allergies to Fluconazole may occur. The prescribing physician should be informed if the patient is allergic to Fluconazole or any similar medications. If any signs of an allergic reaction occur, immediate medical treatment should be sought.

Signs of an allergic reaction to Fluconazole include a rash, itching, hives, swelling of the lips, throat, face, tongue or mouth, wheezing, trouble breathing or tightness in the throat or chest.

Taking Fluconazole along with other medications, including Erythromycin, Quinidine or Voriconazole could cause adverse reactions.

This medication should only be taken for the length of time prescribed. Continuing to take Fluconazole for longer than needed could lead to a second infection.

Children taking Fluconazole should be monitored by their physician. If the child's symptoms worsen, or do not improve as indicated, this should be reported to the prescribing physician.

Severe skin problems including visible rashes have occurred from the use of this medication.

Fluconazole should be taken at least two hours before medication that treats GERD or acid reflux. This includes a proton pump inhibitor.

Resistance to this medication can develop if it is taken too often or for too long. Patients should take Fluconazole only as prescribed to avoid the risk of resistance from overuse.

A higher risk of use exists for Fluconazole than with most topical antifungal medications.

This medication should not be taken by patients with a sensitivity to azoles.

Candida Krusei is inheritently resistant to Fluconazole.

Patients who have or have ever had cancer, AIDS, issues with an irregular heartbeat or who have low levels of calcium, magnesium, potassium or sodium in their blood should inform their physician before taking this medication.

Before surgery or dental procedures, the responsible physician or dentist should be informed that the patient is taking Fluconazole.

In rare cases, the use of Fluconazole may cause seizures.

Fluconazole is not an antibiotic and should not be used to treat bacterial infections.

This medication should not be shared with others or taken by anyone to whom it is not prescribed.

Storage

Fluconazole is available in tablet, capsule and liquid suspension form, and the storage instructions for this medication may vary, based on how it is prescribed. This medication should always be stored in a closed container and away from heat, direct light or moisture. Fluconazole should be stored out of the reach of children and pets.

The mixed liquid suspension form of Fluconazole may be stored in the refrigerator or at room temperature and should be taken within 14 days. The liquid form of this medication should be shaken well before use and only taken with a marked measuring device. Fluconazole should not be frozen.

Tablets should be stored at room temperature away from light and moisture. Fluconazole should not be stored in the bathroom.

Any unused medication should be discarded after 14 days. Fluconazole should not be flushed down the toilet or poured into a drain, unless the patient is instructed to do so by a medical professional. The prescribing physician, a medical facility or a local waste disposal company should be consulted for information on how to properly dispose of this medication.

Summary

Fluconazole is an oral medication, available in tablet, capsule or liquid suspension form and used to treat and prevent yeast or fungal infections in children and adults. It is only available by prescription. This medication may also be used to prevent fungal infections in patients that have received radiation treatment for cancer or a bone marrow transplant. Additionally, Fluconazole can be used to prevent cryptococcal meningitis.

This medication works by killing and preventing the growth of certain types of fungus or yeast. Fluconazole is used to treat and prevent vaginal, oral and esophageal candidiasis, along with yeast infections in other parts of the body.

Fluconazole should only be taken as prescribed and should not be used to treat another infection. This medication should continue to be taken as prescribed, even if symptoms subside, to prevent re-infection. Any unused medication should be disposed of properly within 14 days.

The incidence of side effects with the use of Fluconazole is rare, but may be increased in geriatric patients or those with a history of heart, liver or kidney disease. The risk of developing QT prolongation, a condition which increases the heartbeat, is higher when taking Fluconazole. This risk is further heightened in patients who take this medication while also taking diuretics. An EKG may be ordered before this medication is prescribed for patients with a history of heart problems.

It is important to inform the prescribing physician of any previous medical history, along with any medications, herbs or supplements being taken before taking this medication.

A significant number of medications directly or indirectly interact adversely with Fluconazole. Patients taking any medication, herb or nutritional supplement, along with those who use alcohol, tobacco or marijuana should discuss their use with the prescribing physician to avoid an adverse reaction. In some cases, adverse reactions could be serious.

Fluconazole absorption is not affected by food, so a normal diet can be consumed during the entire course of treatment, unless otherwise indicated by the prescribing physician.

In adults, the dose of Fluconazole prescribed is generally based on the condition being treated, and its severity. In children, Fluconazole is usually prescribed based on weight. The amount of Fluconazole prescribed, or the frequency of its use may be changed based on medical history or past use of the drug. Since resistance to Fluconazole can develop, this medication may not be prescribed if it has been taken in the past.

This medication should not be taken by pregnant women, unless specifically recommended by the prescribing physician. Fluconazole can cause birth defects or spontaneous abortion (miscarriage) and the risk is increased in pregnant women in their first trimester. Hormone-based birth control methods, including birth control pills may not work as effectively when taking Fluconazole, so a backup method should be used for the entire course of treatment. This medication is generally considered safe to use while breastfeeding.

Patients who are lactose or sucrose intolerant, have inherited digestive conditions, or who have difficultly metabolizing certain sugars, should inform the prescribing physician before taking this medication. Certain inactive ingredients found in Fluconazole can cause difficulty for those with these conditions.

Laboratory tests may be given throughout the course of treatment with Fluconazole.