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Fluconazole
Aka: Fluconazole, Diflucan
- Indications
- Onychomycosis
- Yeast Vaginitis (Single dose)
- Dosing
- Tinea Capitis
- Daily: 6 mg/kg/day (up to 150 mg to 300 mg) daily for 3 to 6 weeks
- Weekly: 6 mg/kg/day (up to 150 mg to 300 mg) weekly for 8 to 12 weeks
- Onychomycosis
- Adult: 150 to 300 mg (up to 450 mg) orally once per week
- Child: 3 to 6 mg/kg once weekly
- Course
- Fingernail: 3-6 months
- Toenail: 6-12 months
- Yeast Vaginitis
- Adult dose: 150 mg PO for 1 dose
- Monitoring
- Onychomycosis or Yeast Vaginitis
- No routine lab tests recommended
- Some guidelines have recommended baseline labs
- Complete Blood Count (CBC)
- Liver transaminases (AST, ALT)
- Serum Creatinine
- Adverse effects (5% of patients)
- Nausea
- Headache
- Pruritus
- Liver Function Test abnormalities
-
Drug Interactions
- Absorption not affected by gastric pH
- Significant sedation with Benzodiazepines
- Cimetidine decreases Fluconazole levels
- Hydrochlorothiazide increases Fluconazole levels
- Rifampin decreases Fluconazole levels
- Oral Hypoglycemics (e.g. Sulfonylureas)
- Risk of Hypoglycemia
- Fluconazole increases Theophylline levels
- Increased bleeding risk with Warfarin
- Precautions
- As of 2016, evidence of Miscarriage risk, with even 1-2 doses
- Previously thought safe in pregnancy if limited to occassional single dose
- Mølgaard-Nielsen (2016) JAMA 315(1):58-67 +PMID:26746458 [PubMed]
- References
- Desai (1996) Am Fam Physician 54(4):1337-46 [PubMed]
- Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]
- Gupta (1999) J Am Acad Dermatol 41:237-49 [PubMed]
- Friedlander (1999) Pediatr Infect Dis J 18(2):205-10 [PubMed]
- Wildfeuer (1997) Mycoses 40:259-65 [PubMed]