What does Diflucan help with?
The medication is prescribed to be taken if there is a fungal infection on the genitals of women. Diflucan is effective against vaginal candidiasis.
The drug should also be taken for various other fungal infections associated with the spread of Candida fungus. This disease can be provoked by prolonged use of antibiotics and immunosuppressive treatment. The medicine may also be prescribed for preventive purposes.
Other indications include: cryptococcosis, nail fungus, mycotic skin lesions. The drug is prescribed to both women and men.
Pharmacology and pharmacodynamics
Diflucan belongs to the category of antifungal drugs. The active component effectively copes with various fungi. When taking 50 mg daily for a month, the level of steroid concentration in girls and testosterone in men will not change.
The medication is well absorbed into the digestive system and demonstrates high bioavailability when administered orally. The concentration in the blood is more than 90%. The timing of meals does not affect the activity of the active substance in any way. The maximum content in the blood occurs after 30-80 minutes. Half-life occurs after 30 hours. The effect of taking the drug lasts for 24 hours.
The active component penetrates well into the skin, tissues and internal organs. An increased amount of the active substance is observed in the sweat glands and skin (more than in the blood). It is excreted unchanged by the kidneys.
How to take Diflucan
In the presence of a fungal infection, it will be sufficient to use 150 mg of the drug. For vaginal candidiasis, you need to take 1 capsule. If the disease is chronic, then you need to take the medication in the same amount once every 4 weeks. For prophylactic purposes, the dosage is similar. The duration of therapy can be determined by a specialist, taking into account the characteristics of the disease. In some cases, the dose can be increased to 400 mg, and the therapeutic course can last 1 month.
Drug interactions Diflucan
Anticoagulants: In interaction studies, fluconazole increased prothrombin time (by 12%) in healthy male volunteers receiving warfarin. During post-marketing studies, there were reports of bleeding (bruising, nosebleeds, gastrointestinal bleeding, hematuria and melena) due to an increase in prothrombin time in patients receiving fluconazole concomitantly with warfarin. Similar phenomena were observed with the use of other azoles. Monitoring of prothrombin time is necessary in patients receiving coumarin anticoagulants.
Benzodiazepines (short-acting): when midazolam is prescribed orally, the simultaneous use of fluconazole leads to a significant increase in the concentration of the former in the blood plasma and the development of psychomotor reactions. This effect of midazolam is more pronounced with simultaneous use of fluconazole in the form of oral capsules compared with fluconazole for intravenous administration. If a benzodiazepine drug needs to be prescribed to a patient taking fluconazole, the dose of the latter should be reduced and the patient should be under medical supervision.
Cisapride: with the simultaneous use of fluconazole and cisapride, isolated cases of side effects from the cardiovascular system, such as paroxysms of ventricular tachycardia (torsade de pointes), have been described. Cisapride is contraindicated in patients receiving fluconazole.
Cyclosporine: according to a kinetic study, in kidney recipients, fluconazole at a dose of 200 mg/day increased the concentration of cyclosporine in the blood serum. However, in another study, with repeated doses of fluconazole at a dose of 100 mg/day, no changes in the concentration of cyclosporine in the blood serum of bone marrow recipients were noted. When treating with fluconazole, it is recommended to determine the concentration of cyclosporine in the blood serum.
Hydrochlorothiazide: In healthy volunteers taking fluconazole, repeated administration of hydrochlorothiazide resulted in a 40% increase in fluconazole plasma concentrations. This does not require a change in the fluconazole dosage regimen, but the physician should be aware of this interaction effect.
Oral contraceptives: The pharmacokinetics of a combined oral contraceptive in combination with multiple doses of fluconazole were studied in two studies. When taking fluconazole at a dose of 50 mg/day, no significant effect on hormone levels was observed, while when taking a dose of 200 mg/day, an increase in the AUC of ethinyl estradiol by 40% and levonorgestrol by 24% was observed. This indicates that repeated use of fluconazole in the indicated doses is unlikely to significantly affect the effectiveness of the combined oral contraceptive drug.
Phenytoin: simultaneous administration of Diflucan and phenytoin may be accompanied by an increase in the concentration of phenytoin in the blood plasma to a clinically significant extent. If simultaneous use of two drugs is necessary, dose adjustment and monitoring of phenytoin serum levels is required.
Rifabutin: An interaction between fluconazole and rifabutin has been reported, resulting in increased serum concentrations of the latter. Cases of uveitis have been reported with the simultaneous administration of fluconazole and rifabutin. Patients receiving rifabutin and fluconazole simultaneously require careful monitoring.
Rifampicin: Coadministration of fluconazole and rifampicin resulted in a 25% decrease in AUC and a 20% decrease in fluconazole half-life. In patients receiving both rifampicin and fluconazole, it is advisable to consider the need to increase the dose of the latter.
Sulfonylureas: Fluconazole, when administered concomitantly, increased the half-life of oral hypoglycemic agents of the sulfonylurea group (chlorpropamide, glibenclamide, glipizide and tolbutamide) in healthy volunteers. Fluconazole and sulfonylurea derivatives can be prescribed simultaneously to patients with diabetes mellitus, but the possibility of hypoglycemia should be taken into account.
Tacrolimus: There is a report of an interaction between fluconazole and tacrolimus, which resulted in increased serum concentrations of the latter. Cases of nephrotoxicity have been described with the simultaneous administration of fluconazole and tacrolimus. Patients receiving tacrolimus and fluconazole simultaneously should be monitored.
Terfenadine: Given the occurrence of severe arrhythmias caused by prolongation of the QT in patients who received azole antifungals in combination with terfenadine, clinical studies were conducted. QT prolongation was not observed. In another study, using fluconazole in daily doses of 400 and 800 mg, it was found that the drug significantly increased the concentration of terfenadine in the blood plasma. Co-administration of fluconazole in doses of 400 mg/day or higher with terfenadine is contraindicated. Treatment with fluconazole in doses below 400 mg/day in combination with terfenadine must be carried out under close supervision.
Theophylline: In a placebo-controlled study, fluconazole at a daily dose of 200 mg for 14 days resulted in a reduction in total theophylline clearance by 18%. When treating patients with fluconazole who are receiving high doses of theophylline, or patients with an increased risk of theophylline toxicity, monitor for symptoms of theophylline overdose; if they occur, therapy should be adjusted appropriately.
Zidovudine: In two pharmacokinetic studies, an increase in zidovudine serum concentrations was observed when administered concomitantly with fluconazole, which was most likely due to a decrease in the transformation of zidovudine to its main metabolite. In one study, zidovudine levels were determined in patients with AIDS and ARC (AIDS related complex) before and after treatment with fluconazole 200 mg/day for 15 days. A significant increase in the AUC of zidovudine (20%) was detected. In another randomized, two-stage crossover study, zidovudine levels were determined in HIV-infected patients. Twice with an interval of 21 days, patients received zidovudine 200 mg every 8 hours in combination with or without fluconazole at a dose of 400 mg/day for 7 days. The AUC of zidovudine increased significantly (74%) when administered concomitantly with fluconazole. Patients receiving this combination should be monitored for side effects of zidovudine.
Astemizole: simultaneous use of fluconazole in patients receiving astemizole or other drugs metabolized by the cytochrome P450 system may be accompanied by an increase in the concentration of these drugs in the blood serum. Such patients need to be carefully monitored.
Single or multiple doses of fluconazole at a dose of 50 mg/day did not affect the metabolism of antipyrine (phenazone) when used simultaneously.
It should be borne in mind that the interaction of fluconazole with other drugs has not been specifically studied, but it is possible.
Adverse reactions and overdose
After taking the drug, I rarely experience unwanted reactions, but such cases are still possible.
From the side of the central nervous system: headache, excessive muscle excitability.
From the skin: an allergic reaction manifested by a rash on the skin, the appearance of painful blisters, Lyell's syndrome.
From the digestive system: pain in the stomach, nausea, vomiting, problems with the digestive processes.
An overdose of the drug, manifested by paranoid behavior and hallucinations, is also possible. In this case, you need to do symptomatic treatment and rinse the stomach. It is worth keeping in mind that the medicine is excreted in the urine, so you need to promote the process of urination.
Side effects of the drug Diflucan
Diflucan is generally well tolerated. The following side effects caused by taking the drug were most often observed during clinical studies: from the central nervous system - headache; on the skin - rash; from the digestive tract - abdominal pain, nausea, flatulence, diarrhea. In some patients, especially in those with severe concomitant diseases (AIDS, cancer), changes in blood counts and functional parameters of the kidneys and liver were observed during treatment with fluconazole and similar drugs, but the clinical significance of these changes and their relationship with treatment have not been established; from the liver/biliary tract - toxic liver damage, including isolated cases with fatal outcome, increased activity of alkaline phosphatase, ALT, AST, increased bilirubin levels in the blood serum . In addition, after the introduction of the drug into widespread medical practice, the following side effects were noted: from the nervous system - dizziness, convulsions; on the part of the skin and its appendages - alopecia, exfoliative skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis; from the blood system - leukopenia, including neutropenia and agranulocytosis, thrombocytopenia; from the immune system - anaphylaxis, facial swelling, itching; from the liver/biliary tract - hepatitis, hepatocellular necrosis, jaundice, functional liver failure; from the senses - a change in taste; metabolism - hypercholesterolemia, hypertriglyceridemia, hypokalemia.
How to take Diflucan for children
If the drug is prescribed to children, the optimal dosage can only be determined by the attending physician, taking into account the severity of the disease. A child can be given no more than 400 mg per day. As a rule, the medicine is given to the child once a day.
In infants, the elimination of the active component occurs slowly. Only a specialist should select the dose. In the first 14 days from birth, the baby can be given medicine once every 3 days. From the third week of life, you can give the drug once every two days.
special instructions
Shelf life – 36 months from the date of production. The finished suspension can be kept for no more than 2 weeks. Should be kept in a dry place at room temperature away from children.
Patients with serious liver disease should take the drug with extreme caution, as cases of severe toxic hepatitis have been reported. Liver enzyme levels should be regularly monitored during treatment. For liver diseases, it is strictly forbidden to self-medicate; the drug can only be taken under the constant supervision of a doctor. Toxic hepatitis can be fatal.
If the patient has HIV, then there is a high probability of Lyell's syndrome occurring after taking Diflucan. If a person suffers from cardiovascular diseases, then there is a high probability of arrhythmia, so you need to take the drug carefully.
Many people mistakenly confuse the drug with Duphalac, which is a laxative in its action.
Diflucan capsules - instructions
Capsules are taken orally. It must be swallowed whole with liquid. The effectiveness of the medicine does not depend on food intake.
Adults
Depending on the disease, the drug should be used in different doses. How long can you take Diflucan, in what dosages:
- Meningitis and other diseases caused by cryptococcus - 200-400 mg per day; course therapy is 1.5-2 months. In some cases, you can increase the daily dosage to 800 mg;
- Prevention of relapse of cryptococcal infection - 200 mg per day; The duration of preventive therapy is determined by the doctor.
- Coccidioidomycosis - 200-400 mg per day (sometimes 800 mg). The duration of therapy in some cases reaches 2 years.
- Common candidiasis - 800 mg per day (1 day); further shown 400 mg per day. The course of therapy is up to 2 weeks after the disappearance of symptoms and the first negative blood culture.
The drug treats damage to the mucous membranes. Depending on the location of the damage, treatment tactics will differ:
- Fungal infection of the oral cavity and pharynx - 200-400 mg per day, then 100-200 mg/day. The duration of therapy is up to 3 weeks.
- Atrophic candidiasis of the oral cavity - 50 mg/day for 2 weeks.
- Fungal infection of mucous membranes and skin - 50-100 mg/day for a month.
- Damage to the esophagus - 200-400 mg initial dosage, on the second and subsequent days 100-200 mg/day; course therapy is 2-4 weeks;
- Prevention of candidiasis of the oral mucosa in patients with HIV - 100-200 mg/day or 200 mg three times a day; The duration of treatment is determined individually depending on the severity of HIV symptoms and the duration of the underlying disease.
- Vaginal infection with candida fungus - 150 mg once; then, to prevent the onset of the disease, drink 150 mg every three days (three dosages), then maintenance therapy - 150 mg/week. for 3-6 months.
The medicine effectively copes with fungal diseases of the skin. Treatment regimens for various skin diseases:
- Infectious pathologies of the skin, including dermatophytosis of the legs and torso - 150 mg per week or 50 mg once per day. The duration of course therapy is 14-28 days. If the patient's feet are affected, the duration of treatment is 1.5 months.
- Lichen versicolor - 300-400 mg per week for 1-3 weeks, or 50 mg once per day for 14-28 days.
- Onychomycosis - 150 mg once a week; Therapy continues until the entire nail is renewed.
- Prevention of the occurrence of fungal pathologies in patients with tumor processes - 200-400 mg per day. Therapy is carried out until neutropenia appears; as soon as the number of blood neutrophils has risen to 1000 mm3, treatment begins again for 7 days.
How should children take Diflucan?
For children, the drug is prescribed only by a pediatrician or a specialized specialist who is caring for the child. You should not take the medication yourself. The dosage of the medicine should not be higher than for an adult patient.
The prescribed dose is indicated to be taken once a day. Dosages:
- Damage to mucous membranes - 3 mg/kg/day; on the first day, a high dosage is allowed - 6 mg/kg/day;
- Invasive candidiasis, brain inflammation caused by cryptococcus - 6-12 mg/kg/day; re-exacerbation in HIV patients can be prevented with a dose of 6 mg/kg/day;
- Prevention of fungal infections in neutropenia, immunodeficiencies, cancer pathologies - 3-12 mg/kg/day.
The medication is prescribed only to those children who know how to take capsules. If the child is unable to swallow the encapsulated drug, another antifungal agent is selected for him (in the form of a powder for suspension).
Diflucan for children
