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Indications

Vaginal candidiasis, oropharyngeal & esophageal candidiasis, and cryptococcal meningitis are all treated with fluconazole. It can also be used to treat candida infections in the urinary tract, peritonitis, and systemic candida infections (including candidemia, disseminated candidiasis, and pneumonia).

Pharmacology

Fluconazole is a triazole antifungal that is used to treat fungal infections. It's a strong inhibitor of cytochrome P-450-dependent enzymes in fungi. The ergosterol synthesis is carried out by the Cytochrome P-450 enzyme system, which is an important component of the fungal cell membrane.

Dosage & Administration

Adult (oral)-

Vaginal candidiasis: 150 mg as a single dose.

Oropharyngeal candidiasis: 200 mg on the first day, followed by 100 mg once daily. Clinical evidence of this infection generally resolves within several days, but treatment should be continued for at least 2 weeks to decrease the likelihood of relapse.

Esophageal candidiasis: 200 mg on the first day, followed by 100 mg once daily. Doses up to 400 mg/day may be used. Patients should be treated for a minimum of three weeks and for at least two weeks following the resolution of symptoms.

Systemic candida infections: Optimal therapeutic dosage and duration of therapy have not been established. Sometimes, doses of up to 400 mg daily have been used.

Urinary tract infections caused by candida and peritonitis: 50-200 mg daily have been used.

Cryptococcal meningitis: 400 mg on the first day, followed by 200 mg once daily.

Prophylaxis in patients undergoing bone marrow transplantation: 400 mg once daily.

Child (oral):
 

Doses of 3-6 mg/kg daily have been used. Doses up to 12 mg/kg is recommended.
Intravenous-
 

Adult: Invasive candidal infections including candidaemia and disseminated candidiasis and cryptococcal infections including meningitis, by IV, 400 mg initially then 200 mg daily, increased if necessary to 400 mg daily, treatment continued according to response (at least 6-8 weeks for cryptococcal meningitis)

Child: 6-12 mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate 2-4 weeks old); maximum 400 mg daily. Prevention of relapse of cryptococcal meningitis, by IV, 100-200 mg daily.

Contraindications

When cyclosporin or phenytoin is used with Fluconazole, the plasma level of cyclosporin or phenytoin rises. The prothrombin time is prolonged when Fluconazole and warfarin are taken together. When Fluconazole is used with Rifampicin, the level of Rifampicin is reduced.

Side Effect

Fluconazole is a drug that is well tolerated. Nausea, vomiting, stomach discomfort, diarrhoea, headache, and skin rash are the most frequent Fluconazole side effects.

Pregnancy & Lactation

Fluconazole is classified as a category C drug by the US Food and Drug Administration (FDA) for use during pregnancy. Fluconazole should thus be avoided during pregnancy and breastfeeding unless the potential advantages outweigh the potential hazards to the baby.

Precautions & Warnings

Patients with proarrhythmic disorders should be given fluconazole with care.

Storage Conditions

Keep away from light and heat in a dry area. Keep out of children's reach.