Infectious Disease Book

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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]
Medication Costs
Fluconazole (on 6/18/2017 at Walmart.com)
Fluconazole 150mg #1 tablet for $4.00 $4.00 each
Fluconazole 150mg #3 tablets for $10.00 $3.33 each
fluconazole (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
FLUCONAZOLE 10 MG/ML SUSP Generic $0.31 per ml
FLUCONAZOLE 100 MG TABLET Generic $1.06 each
FLUCONAZOLE 150 MG TABLET Generic $1.67 each
FLUCONAZOLE 200 MG TABLET Generic $1.47 each
FLUCONAZOLE 40 MG/ML SUSP Generic $0.79 per ml
FLUCONAZOLE 50 MG TABLET Generic $1.05 each
diflucan (on 6/1/2017 at Medicaid.Gov Pharmacy Drug pricing)
DIFLUCAN 150 MG TABLET Generic $1.67 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Fluconazole (C0016277)

Definition (CHV) a kind of antifungal drug
Definition (NCI_NCI-GLOSS) A drug that treats infections caused by fungi.
Definition (NCI) A synthetic triazole with antifungal activity. Fluconazole preferentially inhibits fungal cytochrome P-450 sterol C-14 alpha-demethylation, resulting in the accumulation of fungal 14 alpha-methyl sterols, the loss of normal fungal sterols, and fungistatic activity. Mammalian cell demethylation is much less sensitive to fluconazole inhibition.
Definition (MSH) Triazole antifungal agent that is used to treat oropharyngeal CANDIDIASIS and cryptococcal MENINGITIS in AIDS.
Definition (CSP) alpha-(2,4-difluorophenyl)-alpha- (1,2,4-triazol-1-ylmethyl)-1,2, 4- triazole-1-ethanol; an antifungal with potential efficacy for patients unable to take amphotericin B or who are immunologically compromised, as in AIDS.
Definition (PDQ) A synthetic triazole with antifungal activity. Fluconazole preferentially inhibits fungal cytochrome P-450 sterol C-14 alpha-demethylation, resulting in the accumulation of fungal 14 alpha-methyl sterols, the loss of normal fungal sterols, and fungistatic activity. Mammalian cell demethylation is much less sensitive to fluconazole inhibition. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40842&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40842&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C500" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D015725
SnomedCT 31865003, 387174006
LNC LP14993-7, MTHU002296
English 1H-1,2,4-Triazole-1-ethanol, alpha-(2,4-difluorophenyl)-alpha-(1H-1,2,4-triazol-1-ylmethyl)-, alpha-(2,4-difluorophenyl)-alpha- (1,2,4-triazol-1-ylmethyl)-1,2, 4- triazole-1-ethanol, fluconazole, FLUCONAZOLE, Fluconazole, fluconazole (medication), Fluconazole [Chemical/Ingredient], Fluconazole product, Fluconazole (product), Fluconazole (substance), FCZ
Swedish Flukonazol
Czech flukonazol
Finnish Flukonatsoli
Russian FLUKONAZOL, ФЛУКОНАЗОЛ
Japanese フルコナゾール
Polish Flukonazol
Spanish fluconazol (producto), fluconazol (sustancia), fluconazol, Fluconazol
French Fluconazole
German Fluconazol
Italian Fluconazolo
Portuguese Fluconazol
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Diflucan (C0699601)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D015725
English diflucan, Diflucan, Pfizer Brand of Fluconazole, Triflucan
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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