Fluconazole

Aka: Fluconazole, Diflucan

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