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Flunol

Inside, intravenously (at a rate of no more than 20 mg/min).

For adults, with cryptococcal infections, candidemia, disseminated candidiasis, and other invasive candidiasis infections, 400 mg is prescribed on 1 day, then 200-400 mg 1 time per day. The duration of treatment depends on the clinical and mycological response (for cryptococcal meningitis it is at least 6-8 weeks).

To prevent cryptococcal meningitis in patients with AIDS, therapy at a dose of 200 mg/day can be continued for a long time.

For oropharyngeal candidiasis - 50-100 mg 1 time per day for 7-10 days, in patients with immunosuppression - 14 days or more.

To prevent relapses of oropharyngeal candidiasis in patients with AIDS after completing the full course of primary therapy - 150 mg once a week.

For atrophic oral candidiasis associated with wearing dentures - 50 mg once a day for 14 days in combination with local antiseptic drugs to treat the denture.

For other candidiasis of the mucous membranes (with the exception of genital candidiasis) - 50-100 mg/day, duration of treatment - 14-30 days.

For vaginal candidiasis - 150 mg once, orally. To reduce the frequency of relapses, use 150 mg once a month for 4-12 months, sometimes more frequent use may be required.

For balanitis caused by Candida - 150 mg/day once.

For the prevention of candidiasis, the recommended dose is 50-400 mg/day, depending on the degree of risk of developing a fungal infection. If there is a high risk of generalized infection, for example in patients with expected severe or long-lasting neutropenia, the recommended dose is 400 mg/day. The drug is prescribed several days before the expected onset of neutropenia; after the number of neutrophils increases to more than 1 thousand/μl, treatment is continued for another 7 days.

For skin lesions, including mycoses of the feet, skin of the groin area, and candidiasis - 150 mg once a week or 50 mg once a day, duration of treatment - 2-4 weeks (up to 6 weeks for mycoses of the feet).

For pityriasis versicolor - 300 mg once a week for 2 weeks, some patients require a third dose of 300 mg per week, while in some cases a single dose of 300-400 mg is sufficient; An alternative treatment regimen is to use 50 mg once a day for 2-4 weeks.

For onychomycosis - 150 mg once a week; Treatment continues until the infected nail is replaced. It normally takes 3-6 months and 6-12 months for fingernails and toenails to re-grow, respectively.

For deep endemic mycoses - 200-400 mg/day for up to 2 years. The duration of therapy is determined individually; it can be 11-24 months for coccidioidomycosis, 2-17 months for paracoccidioidomycosis, 1-16 months for sporotrichosis and 3-17 months for histoplasmosis.

In children, as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. In children, the drug should not be used in a daily dose that would exceed that in adults. The drug is used daily once a day (special dosage forms for children are used).

Children with esophageal candidiasis are prescribed 3 mg/kg/day once for at least 3 weeks and for 2 weeks after symptom regression; for candidiasis of the mucous membranes - 3 mg/kg/day once for at least 3 weeks; in the treatment of generalized candidiasis and cryptococcal infection (including meningitis) - 6-12 mg/kg/day for 10-12 weeks (until laboratory confirmation of the absence of pathogens in the cerebrospinal fluid).

For the prevention of fungal infections in children with reduced immunity, in whom the risk of developing infection is associated with neutropenia developing as a result of cytotoxic chemotherapy or radiation therapy, 3-12 mg/kg/day, depending on the severity and duration of persistence of induced neutropenia.

For newborns, the interval between administrations of the drug is 72 hours; for children aged 2-4 weeks, the same dose is administered at intervals of 48 hours.

In children with impaired renal function, the daily dose of the drug should be reduced (in the same proportion as in adults) in accordance with the severity of renal failure.

In elderly patients in the absence of renal dysfunction, the usual dosage regimen of the drug should be followed. In patients with renal failure (creatinine clearance less than 50 ml/min), the dosage regimen should be adjusted as follows.

For chronic renal failure, a “loading” dose of 50-400 mg is initially administered; with CC more than 50 ml/min, the usual daily dose is prescribed, with CC 11-50 ml/min - 50% of the recommended dose or the usual dose 1 time every 2 days; for patients on hemodialysis - 1 dose after each dialysis.

Instructions for medical use of the drug

FLUNOL® 50 FLUNOL® 150

International nonproprietary name

Fluconazole

Dosage form

Capsules 50 mg, 150 mg

Compound

One capsule contains the active substance - fluconazole 50 mg and 150 mg, excipients: lactose monohydrate, colloidal silicon dioxide (Aerosil 200), corn starch, magnesium stearate, sodium lauryl sulfate, capsule shell composition: body: titanium dioxide (E 171), gelatin , cap for dosage 50 mg: titanium dioxide E 171, sparkling black (E151), gelatin cap for dosage 150 mg: titanium dioxide E 171, iron oxide (III) red (E 172), gelatin Description Hard gelatin capsules size No. 3 c matte white body and matte dark blue cap (for a dosage of 50 mg). Hard gelatin capsules size No. 1 with a matte white body and a matte pink cap (for a dosage of 150 mg).

Pharmacotherapeutic group

Antifungal drugs for systemic use. Triazole derivatives. Fluconazole. Pharmacological properties

Pharmacokinetics

Fluconazole is well absorbed after oral administration, bioavailability is more than 90%. Eating does not affect the absorption of the drug. The maximum concentration is reached after 0.5 - 1.5 hours. Fluconazole penetrates well into body fluids. Levels of fluconazole in saliva and sputum approach its concentration in plasma. In patients with fungal meningitis, the level of fluconazole in the cerebrospinal fluid is about 80% of its plasma level. In the stratum corneum of the epidermis, dermis and sweat glands, high concentrations of fluconazole are achieved, which exceed serum concentrations. Fluconazole binds poorly to plasma proteins (12%). The half-life is 30 hours. Not metabolized. No fluconazole metabolites were detected in peripheral blood. Fluconazole is excreted primarily by the kidneys; approximately 80% of the dose taken is found unchanged in the urine. Pharmacokinetics in special clinical cases In children, the following pharmacokinetic parameters of fluconazole were identified: Age of children Dose (mg/kg) Half-life (hour) AUC (mcg h/ml) 11 days - 11 months Single dose - 3 mg/kg 23 110.1 9 months - 13 years Single dose - orally 2 mg/kg 25.0 94.7 9 months - 13 years Single dose - orally 8 mg/kg 19.5 362.5 5 years - 15 years Repeated dose - 2 mg/kg 17.4 67.4 5 years - 15 years Repeated dose - 4 mg/kg 15.2 139.1 5 years-15 years Repeated dose - 8 mg/kg 17.6 196.7 Average age 7 years Repeated dose - orally 3 mg/kg 15.5 41.6 For premature children (about 28 weeks of development), fluconazole was administered intravenously at a dose 6 mg/kg every 3rd day until a maximum of 5 doses are administered while children remain in the intensive care unit (ICU). The average T1/2 was 74 hours on day 1, decreasing on the 7th day to an average of 53 hours and on the 13th day to an average of 47 hours (range 27-68 hours). AUC values were 271 mcg x h/mL on day 1, increased to 490 mcg x h/mL on day 7, and decreased to an average of 360 mcg x h/mL by day 13. Vd was 1183 ml/kg on day 1, then increased to an average of 1184 ml/kg on day 7 and to 1328 ml/kg on day 13.

Pharmacodynamics Fluconazole

– a representative of the class of triazole antifungal agents, is a selective inhibitor of ergosterol synthesis in the fungal membrane. Increases the permeability of the cell membrane, disrupts its growth and replication. Pharmacological effect - fungicidal. It has a specific effect on fungal enzymes dependent on cytochrome P450. Does not have antiandrogenic activity. Treatment with fluconazole 50 mg/day for 28 days did not affect blood testosterone concentrations in men or steroid concentrations in women of childbearing age. Fluconazole is effective against superficial and systemic fungal infections caused by Candida spp., Cryptococcus neoformans, Coccidiodes immitis, Microsporum spp., Trichophyton spp., Blastomyces dermatitidis, Histoplasma capsulatum.

Indications for use

- genital candidiasis, acute or recurrent vaginal candidiasis, prophylaxis to reduce the frequency of relapses of vaginal candidiasis, candidal balanitis - candidiasis of the mucous membranes, including the mucous membranes of the mouth, pharynx, esophagus, non-invasive bronchopulmonary infections, candiduria, mucocutaneous and chronic atrophic candidiasis oral cavity - dermatomycosis, including mycoses of the feet, smooth skin of the trunk, limbs, pityriasis versicolor, skin candidal infections - generalized candidiasis, including candidemia, disseminated candidiasis and other forms of invasive candidal infections, such as infections of the peritoneum, endocardium, respiratory and urinary tract, in including in patients with malignant tumors who are in intensive care units and receiving cytotoxic or immunosuppressive therapy, as well as in patients with other factors predisposing to the development of candidiasis - cryptococcosis, including cryptococcal meningitis and infections of other localizations (for example, lungs, skin), incl. in patients with a normal immune response and patients with AIDS, organ transplant recipients and patients with other forms of immunodeficiency; maintenance therapy to prevent relapses of cryptococcosis in patients with AIDS - prevention of fungal infections in patients with malignant neoplasms predisposed to the development of such infections as a result of cytotoxic chemotherapy or radiation therapy

Directions for use and doses

Adults: - for oropharyngeal candidiasis, on the first day the drug is usually prescribed at 200 mg, then continued at 100 mg once a day. Treatment is continued for 2 weeks to reduce the likelihood of relapse. — For vaginal candidiasis, take a single dose orally at a dose of 150 mg. To reduce the frequency of relapses of vaginal candidiasis, the drug can be used at a dose of 150 mg once a month. The duration of therapy is determined individually - it varies from 4 to 12 months. — For chronic recurrent vulvo-vaginal candidiasis (relapse rate 4 or more times a year), pulse therapy is recommended: 150 mg once a week for 1-3 months. — For candidal balanitis – 150 mg once. — For mycosis of the skin, the recommended dose is 150 mg once a week. The duration of therapy in normal cases is 2-4 weeks, however, with mycoses of the feet, longer therapy (up to 6 weeks) may be required. — For onychomycosis, the recommended dose is 150 mg once a week. Treatment should be continued until an uninfected nail grows out. Fingernails and toenails normally take 3-6 and 6-12 months to re-grow, respectively. — For pityriasis versicolor, 300 mg once a week for 2 weeks. The maximum daily dose for adults should not be exceeded in children. Fluconazole is taken every day in a single dose. For the treatment of generalized candidiasis and cryptococcal infection, the recommended dose is 6-12 mg/kg/day, depending on the severity of the disease. For the prevention of fungal infections in patients with immunodeficiency, considered at risk due to neutropenia, receiving cytotoxic chemotherapy or radiation therapy, the drug is prescribed at 3-12 mg/kg/day, depending on the severity and duration of persistence of induced neutropenia. Use in the elderly In the absence of signs of renal failure, the drug is prescribed at the usual dose. Use in patients with renal failure With a single dose, no dose change is required. In patients with impaired renal function, with repeated use of the drug, a loading dose of 50 mg to 400 mg should be initially administered, after which the daily dose (depending on the indication) is set according to the following table: Creatinine clearance (ml/min) Percentage of recommended dose > 50 ≤50 (without dialysis) Regular dialysis 100% 50% 100% after each dialysis Patients on regular dialysis should receive 100% of the recommended dose after each dialysis; on days when there is no dialysis, patients should receive a reduced dose according to their creatinine clearance.

Side effects

Common (from ≥1/100 to <1/10) - headache - abdominal pain, diarrhea, nausea, vomiting - increased levels of alkaline phosphatase, serum aminotransferase levels (ALT and AST) - rash Uncommon (from ≥1/1,000 to ≤1/100) - insomnia, drowsiness - convulsions, dizziness, paresthesia, change in taste - vertigo - dyspepsia, flatulence, dry mouth - cholestasis, jaundice, increased bilirubin - itching, urticaria, increased sweating, dermatitis - myalgia - fatigue, malaise , weakness, increased body temperature Rarely (from ≥1/10,000 to ≤1/1,000) - agranulocytosis, leukopenia, neutropenia, thrombocytopenia - anaphylaxis, angioedema - hypertriglyceridemia, hypercholesterolemia, hypokalemia - tremor - tachycardia, ventricular fibrillation/flutter, increased interval QT - hepatotoxicity, including rare cases with fatal outcome, liver failure, hepatocellular necrosis, hepatitis, hepatocellular damage - toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, exfoliative dermatitis, facial edema, alopecia In patients with AIDS or cancer, with During treatment with fluconazole and similar drugs, changes in blood counts, renal and liver function were observed, but the clinical significance of these changes and their relationship with treatment have not been established.

Contraindications

hypersensitivity to fluconazole, other components of the drug or azole substances with a structure similar to fluconazole - simultaneous use of terfenadine during repeated doses of fluconazole at a dose of 400 mg / day or more - simultaneous use of drugs that prolong the QT interval and are metabolized by the CYP3A4 enzyme, such as cisapride, astemizole, erythromycin, pimozide and quinidine  hereditary lactose intolerance, Lapp-lactase enzyme deficiency, glucose-galactose malabsorption  pregnancy and lactation period  children under 18 years of age With caution Impaired liver function tests during the use of fluconazole; the appearance of a rash during the use of fluconazole in patients with superficial fungal infection and invasive/systemic fungal infections; potentially proarrhythmic conditions in patients with multiple risk factors (organic heart disease, electrolyte imbalance and concomitant therapy that contributes to the development of such disorders).

Drug interactions

With simultaneous use of FLUNOL® 50, FLUNOL® 150: - with coumarin anticoagulants - fluconazole increases prothrombin time. Patients receiving coumarin anticoagulants should be under strict medical supervision - with cisapride - cases of adverse cardiac events have been described, including paroxysms of ventricular tachycardia (AR) - with cyclosporine - monitoring of the concentration of cyclosporine in the blood is recommended, as it may increase; - with hydrochlorothiazide - leads to an increase in the concentration of fluconazole in the blood by 40%. However, this does not require a change in dosage regimen - with ethinyl estradiol and levonorgestrel - fluconazole increases their areas under the concentration-time curve (AUC). However, this does not affect the effectiveness of the combined oral contraceptive drug - with phenytoin - a significant increase in phenytoin concentrations may be observed. If it is necessary to use combined treatment with phenytoin, monitoring the level of the latter is necessary, and adequate dose selection to ensure therapeutic concentrations in serum - with rifampicin - leads to a decrease in AUC of fluconazole by 25% and T1/2 by 20%. It is necessary to take into account the advisability of increasing the dose of fluconazole - with oral hypoglycemic agents (sulfonylurea derivatives) - fluconazole prolongs their half-life. Frequent monitoring of blood glucose and a corresponding reduction in the dose of sulfonylurea are recommended - with antifungals from the group of azole derivatives, with terfenadine and astemizole - the likelihood of developing serious arrhythmias with prolongation of the QT interval increases (if necessary, the use of such a combination requires careful medical monitoring) - with theophylline - possible prolongation the half-life of theophylline from plasma and the development of symptoms of its overdose; - with zidovudine - leads to an increase in the concentration of zidovudine in plasma. Patients receiving this combination should be monitored for side effects of zidovudine - with antipyrine - fluconazole at a dose of 50 mg does not affect the metabolism of antipyrine - with midazolam - fluconazole significantly increases the concentration of midazolam and psychomotor effects; - with triazolam - increases the AUC of triazolam (single dose) by approximately 50%, Cmax by 20-32% and t½ by 25-50%, due to inhibition of triazolam metabolism. Triazolam dose adjustment may be required - with benzodiazepines - close monitoring is necessary to ensure appropriate benzodiazepine dose reduction - with calcium channel blockers (nifedipine, isradipine, amlodipine, verapamil and felodipine) - fluconazole may significantly increase the systemic exposure of calcium channel antagonists. Frequent monitoring for side effects of drugs is recommended - with non-steroidal anti-inflammatory drugs (celecoxib, flurbiprofen, ibuprofen, naproxen, lornoxicam, meloxicam, diclofenac) - increases the Cmax and AUC of NSAIDs. Frequent monitoring for NSAID-related adverse effects and toxicities is recommended. Dose adjustment may be required. NSAIDs - with cyclophosphamide - increases serum bilirubin and creatinine levels. The combination can be used before there is a risk of increased serum bilirubin and creatinine levels - with fentanyl - fluconazole significantly delays the elimination of fentanyl. Elevated concentrations of fentanyl can lead to respiratory failure - alfentanil: with simultaneous therapy with fluconazole, a decrease in clearance and volume of distribution, as well as a prolongation of the elimination period of alfentanil, is observed. A possible mechanism of action is inhibition of the CYP3A4 enzyme by fluconazole. A dose adjustment of alfentanil may be required - with halofantrine - fluconazole may increase plasma concentrations of halofantrine due to an inhibitory effect on CYP3A4; - with hydroxymethylglutaryl-A reductase (HMG-CoA reductase) inhibitors - the risk of myopathy and acute skeletal muscle necrosis (rhabdomyolysis) increases when fluconazole is prescribed concomitantly with HMG-CoA reductase inhibitors that are metabolized through CYP3A4, such as atorvastatin and simvastatin, or via CYP2C9, such as fluvastatin. If concomitant therapy is necessary, the patient should be observed for symptoms of myopathy and rhabdomyolysis, and creatine kinase levels should be monitored. HMG-CoA reductase inhibitors should be discontinued if a significant increase in creatine kinase levels is observed, or if myopathy/rhabdomyolysis is diagnosed or suspected - with losartan - fluconazole inhibits the metabolism of losartan to its active metabolite (E-31 74), which is responsible for most antagonism of angiotensin II receptors, which occurs during treatment with losartan. Patients should monitor blood pressure closely - with methadone - serum concentrations of methadone increase, methadone dosage adjustment may be required - with vinca alkaloid - may increase plasma levels of vinca alkaloid (eg, vincristine and vinblastine) and lead to neurotoxicity due to inhibitory effects on CYP3A4 - with vitamin A - careful monitoring of patients is required in order to identify side effects associated with the central nervous system - with voriconazole - simultaneous administration of voriconazole and fluconazole at any dose is not recommended. Concomitant use of oral voriconazole (400 mg every 12 hours on day 1, then 200 mg every 12 hours for 2.5 days) and oral fluconazole (400 mg on day 1, then 200 mg every 24 hours for 4 days) led to an increase in the concentration and AUC of voriconazole by an average of 57% (9% CI: 20%, 107%) and 79% (90% CI: 40%, 128%), respectively - with cimetidine, antacids - no clinically significant effect was observed on the absorption of fluconazole - with prednisolone - patients on long-term treatment with fluconazole and prednisolone should be monitored for the development of adrenal insufficiency after discontinuation of fluconazole - with rifabutin - increases serum rifabutin levels up to 80%. Cases of uveitis have been reported in patients who were simultaneously prescribed fluconazole and rifabutin. Careful monitoring of the condition of patients receiving rifabutin and fluconazole simultaneously with saquinavir is necessary - the AUC of saquinavir increases by approximately 50%, Cmax by approximately 55% and reduces the clearance of saquinavir by approximately 50% due to inhibition of the hepatic metabolism of saquinavir via CYP3A4 and inhibition of P-glycoprotein. Dose adjustments of saquinavir may be necessary; - with sirolimus - the plasma concentration of sirolimus increases, presumably by inhibiting the metabolism of sirolimus through CYP3A4 and P-glycoprotein. This combination may be used to adjust the dose of sirolimus based on effect/concentration measurements; - with tacrolimus - serum concentrations of tacrolimus when taken orally may increase up to 5-fold due to inhibition of the metabolism of tacrolimus in the intestine via CYP3A4. No significant pharmacokinetic changes were observed with intravenous tacrolimus. Increased tacrolimus levels have been associated with nephrotoxicity. The dosage of oral tacrolimus should be reduced depending on the concentration of the drug - amitriptyline, nortriptyline: fluconazole enhances the effect of amitriptyline and nortriptyline. Concentrations of 5-nortriptyline and/or S-amitriptyline may be measured at the start of combination therapy and after one week. If necessary, the dose of amitriptyline/nortriptyline should be adjusted - carbamazepine: fluconazole inhibits the metabolism of carbamazepine and increases the concentration of the latter in the blood serum by 30%. There is a risk of carbamazepine toxicity. Carbamazepine dosage adjustments may be necessary based on concentration/effect measurements.

special instructions

Treatment must be continued until clinical and mycological remission of the disease occurs. Premature cessation of treatment leads to relapses. Treatment can begin before receiving the results of culture or other laboratory tests, with subsequent correction of fungicidal therapy based on the results of the studies. During treatment, it is necessary to monitor blood counts, kidney and liver function. If renal or liver dysfunction occurs, you should stop taking the drug. In rare cases, the use of fluconazole was accompanied by toxic changes in the liver, including death, mainly in patients with concomitant diseases. Patients whose liver function tests are impaired during treatment with fluconazole should be monitored for signs of liver damage. If clinical signs or symptoms of liver damage appear that may be associated with the use of fluconazole, the drug should be discontinued. The hepatotoxic effect of fluconazole is usually reversible, and symptoms disappear after discontinuation of therapy. If skin rashes occur in patients with immunosuppression, careful observation is necessary, and if the skin reaction progresses, treatment should be discontinued (risk of developing Stevens-Johnson syndrome, Lyell's syndrome). People with AIDS are more likely to develop severe skin reactions. If a patient receiving treatment for a superficial fungal infection develops a rash that can be associated with fluconazole, the drug should be discontinued. If a rash appears in patients with invasive/systemic fungal infections, they should be closely monitored and fluconazole should be discontinued if bullous lesions or erythema multiforme appear. In rare cases, anaphylactic reactions have been observed. Fluconazole may cause prolongation of the QT interval on the ECG. When using fluconazole, an increase in the QT interval and ventricular fibrillation/flutter were observed very rarely in patients with multiple risk factors, such as organic heart disease, electrolyte imbalances and concomitant therapy that contributes to the development of such disorders. Therefore, fluconazole should be used with caution in such patients with potentially proarrhythmic conditions. Patients with liver, heart and kidney diseases are advised to consult a doctor before use. When using Flunol® 50 mg or Flunol® 150 for vaginal candidiasis, patients should be warned that improvement in symptoms is usually observed after 24 hours, but sometimes takes several days for them to completely disappear. Fluconazole is a strong CYP2C9 inhibitor and a moderate CYP3A4 inhibitor. Patients receiving treatment with fluconazole who are taking concomitant therapy with drugs with a narrow therapeutic window that are metabolized through CYP2C9 and CYP3A4 should be monitored. Flunol® 50 or Flunol® 150 should be taken with caution by patients with renal dysfunction. Pediatric Population The examples and incidence of adverse events and laboratory abnormalities observed in children are comparable to those observed in adults. Pregnancy and lactation During pregnancy, the use of the drug should be avoided, except in patients with severe or potentially life-threatening fungal infection for whom fluconazole can be used if the expected benefit is higher than the possible risk to the fetus. Use during breastfeeding Fluconazole has been found in breast milk at concentrations similar to those found in plasma and is therefore not recommended for use in nursing mothers. Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous machinery Patients should be informed about the dangers associated with driving vehicles, servicing mechanical equipment and other potentially hazardous activities. Overdose Symptoms: hallucinations, paranoid behavior. Treatment: supportive and symptomatic therapy is used, if necessary, gastric lavage. Since fluconazole is excreted primarily in the urine, forced diuresis is likely to increase the rate of elimination. A 3-hour hemodialysis session reduces the plasma concentration of fluconazole by approximately 50%.

Release form

and packaging 7 capsules (for a dosage of 50 mg) or 1 or 2 capsules (for a dosage of 150 mg) are placed in a blister pack made of transparent polyvinyl chloride film and printed aluminum foil. 1 or 2 (for a dosage of 50 mg) or 1 (for a dosage of 150 mg) blister packs together with instructions for medical use in the state and Russian languages are placed in a cardboard pack with a hologram of the manufacturer .

Storage conditions

In a dry place, protected from light, at a temperature not exceeding 25 0C. Keep out of the reach of children!

Shelf life

4 years Do not use after expiration date
Attention! The description of the drug on this page is simplified. Before purchasing and using the drug, consult your doctor or pharmacist, and also read the instructions approved by the manufacturer. Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. ATTENTION! This section is provided for informational purposes only and is not a catalog or price list of our company. To obtain information about the availability of drugs, call + 99871 202 0999 Pharmacy Network Helpline 999.

Fluconazole

Inside.

For adults with cryptococcal meningitis and cryptococcal infections of other localizations, 400 mg is usually prescribed on the first day, and then treatment is continued at a dose of 200 mg - 400 mg 1 time / day. The duration of treatment for cryptococcal infections depends on clinical effectiveness confirmed by mycological examination; for cryptococcal meningitis, it is usually continued for a minimum of 6-8 weeks.

To prevent relapse of cryptococcal meningitis in AIDS patients, after completing the full course of primary treatment, fluconazole is prescribed at a dose of 200 mg/day for a long period of time.

For candidemia, disseminated candidiasis and other invasive candidal infections, the dose is usually 400 mg on the first day, and then 200 mg each. If clinical effectiveness is insufficient, the dose of the drug can be increased to 400 mg/day. The duration of therapy depends on clinical effectiveness.

For oropharyngeal candidiasis, the drug is usually prescribed 50-100 mg 1 time/day; Duration of treatment is 7-14 days. If necessary, in patients with a pronounced decrease in immunity, treatment may be longer. To prevent relapses of oropharyngeal candidiasis in patients with AIDS after completing the full course of primary therapy, the drug can be prescribed at a dose of 150 mg once a week.

For atrophic candidiasis of the oral cavity associated with wearing dentures, fluconazole is usually prescribed 50 mg 1 time / day for 14 days in combination with local antiseptics

means for processing the prosthesis. For other localizations of candidiasis (except for genital candidiasis), for example, with esophagitis, non-invasive bronchopulmonary

lesions, candiduria, candidiasis of the skin and mucous membranes, etc., the effective dose is usually 50-100 mg/day with a treatment duration of 14-30 days.

For vaginal candidiasis, fluconazole is taken orally once at a dose of 150 mg. To reduce the frequency of relapses of vaginal candidiasis, the drug can be used at a dose of 150 mg once a month. The duration of therapy is determined individually; it varies from 4 to 12 months. Some patients may require more frequent use.

For balaiitis caused by Candida spp., fluconazole is prescribed as a single dose of 150 mg orally.

For the prevention of candidiasis, the recommended dose of fluconazole is 50-400 mg 1 time / day, depending on the degree of risk of developing a fungal infection. If there is a high risk of generalized infection, for example in patients with expected severe or long-lasting neutropenia, the recommended dose is 400 mg 1 time / day. Fluconazole is prescribed several days before the expected onset of neutropenia; after the number of neutrophils increases to more than 1000/mm3, treatment is continued for another 7 days.

For mycoses ruts, including mycoses of the feet, ruts of the groin area, and caididosis ruts, the recommended dose is 150 mg once a week or 50 mg once a day. The duration of therapy in normal cases is 2-4 weeks, however, with mycoses of the feet, longer therapy (up to 6 weeks) may be required.

For pityriasis versicolor - 300 mg

1 time per week for 2 weeks, some patients require a third dose of 300 mg per week, while in some cases a single dose of 300 mg - 400 mg is sufficient; An alternative treatment regimen is to use 50 mg once a day for 4 weeks.

For onychomycosis, the recommended dose is 150 mg once a week. Treatment should be continued until the infected nail is replaced (the uninfected nail regrows). Fingernails and toenails require 6 months and 6-12 months, respectively, to re-grow. However, growth rate can vary widely between individuals and also depending on age.

For deep endemic mycoses, it may be necessary to use the drug at a dose of 200 - 400 mg/day for up to 2 years. The duration of therapy is determined individually; it can be 1 1-24 months for coccidioidomycosis; 2-17 months for paracoccidioidomycosis; 1-16 months for sporotrichosis and 3-17 months for histoplasmosis.

In children, as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. In children, the drug should not be used in a daily dose that would exceed that in adults, that is, no more than 400 mg per day. The drug is used daily 1 time/day.

For esophageal candidiasis in children, fluconazole is prescribed once at a daily dose of 3 mg/kg, in the following average doses: at the age of 3-6 years (body weight 15-20 kg) - 50 mg; at the age of 7-9 years (body weight 21-29 kg) - 50-100 mg; at the age of 10-12 years (body weight 30-40 kg) - 100-150 mg; at the age of 12-15 years (body weight 40-50 kg) - 100-150 mg. Duration of therapy is at least 3 weeks and another 2 weeks after symptom regression.

For candidiasis of the mucous membranes in children, fluconazole is prescribed once at a daily dose of 3 mg/kg, in the following average doses: at age

3-6 years (body weight 15-20 kg) - on the 1st day 100-150 mg, then - 50 mg; at the age of 7-9 years (body weight 21-29 kg) - on the 1st day 100-200 mg, then 100 mg each; at the age of 10-12 years old (body weight 30-40 kg) - on the 1st day 100-150 mg, then - 50-100 mg each; at the age of 12-15 years (body weight 40-50 kg) - on the 1st day 250-300 mg, then 100-150 mg. The duration of therapy is at least 3 weeks.

For generalized candidosis and cryptococcal infection (including meningitis) in children, fluconazole is prescribed once in a daily dose of 6-12 mg/kg, in the following average doses: at the age of 3-6 years (body weight 15-20 kg) - 100-250 mg; at the age of 7-9 years (body weight 21-29 kg) - 100-300 mg; at the age of 10-12 years (body weight 30-40 kg) - 200-350 mg; at the age of 12-15 years (body weight 40-50 kg) - 250-400 mg. Duration of therapy - for 10-12 weeks (until laboratory confirmation

absence of pathogens in the liquor). For the prevention of fungal infections in children with reduced immunity, in whom the risk of developing infection is associated with neutropenia developing as a result of cytotoxic chemotherapy or radiation therapy, fluconazole is prescribed at a dose of 3-12 mg/kg/day, depending on the severity and duration of persistence of induced neutropenia, in the following average doses: at the age of 3-6 years (body weight 15-20 kg) - 50-250 mg; at the age of 7-9 years (body weight 21-29 kg) - 50-300 mg; at the age of 10-12 lay down (weight

body 30-40 kg) - 100-350 mg; at the age of 12-15 years (body weight 40-50 kg) - 100-400 mg. The duration of therapy is until the induced neutropenia is eliminated.

In children with impaired night , the daily dose of the drug should be reduced (in the same proportion as in adults), in accordance with the severity of renal failure.

In elderly patients in the absence of renal dysfunction, the usual dosage regimen of the drug should be followed. Patients with renal failure (clearance

creatinine less than 50 ml/min), the dosage regimen should be

adjust as below. Use of the drug in patients with impaired renal function. Fluconazole is excreted mainly unchanged in the urine. When taken once, no dose change is required. When re-prescribing the drug to patients with impaired renal function, a “loading” dose of 50 mg to 400 mg should first be administered. If creatinine clearance (CC) is 50 ml/min, the usual dose of the drug (100% of the recommended dose) is used once a day. When CC is from 11 to 50 ml/min, a dose equal to 50% of the recommended dose is used. For patients regularly on dialysis, one dose of the drug is administered after each hemodialysis session.