Category D when used for all other indications (e.g., treatment of oropharyngeal or esophageal candidiasis, cryptococcal meningitis, prevention of Candida infections). It's a recommended treatment option for vaginal yeast infections due to Candida and more severe cases of oral thrush (yeast infection in the mouth). Widely distributed into body tissues and fluids following oral or IV administration. Call your doctor if your skin or eyes become yellow, your urine turns a darker color, your stools (bowel movements) are light-colored, or if you vomit or feel like vomiting or if you have severe skin . HIV-infected infants and children with mild to moderate coccidioidomycosis (e.g., focal pneumonia): 612 mg/kg (up to 400 mg) once daily. Vulvovaginal candidiasis frequently occurs during pregnancy. Treatment failures or relapses reported when an oral azole (e.g., ketoconazole) was used in treatment of cutaneous or pulmonary blastomycosis in patients who had asymptomatic or subclinical CNS involvement at the time of initial diagnosis. CDC states use topical (intravaginal) azole antifungals (not oral fluconazole) for treatment of vulvovaginal candidiasis during pregnancy. HIV-infected adults with severe coccidioidomycosis (e.g., diffuse pulmonary infection): 400 mg once daily. IDSA states fluconazole is a reasonable alternative in those who have not been receiving fluconazole prophylaxis; AAP states fluconazole can be considered for follow-up (step-down) therapy after initial response to IV amphotericin B. Fluconazole also has been used for prophylaxis to reduce the incidence of invasive candidiasis in low birthweight neonates [off-label] at high risk. Use with caution in nursing women. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. For treatment of cryptococcal CNS infections in organ transplant recipients, IDSA recommends induction therapy with IV amphotericin B given in conjunction with oral flucytosine for at least 2 weeks, then consolidation therapy with oral fluconazole given for 8 weeks. Insufficient experience in controlled clinical studies in patients 65 years of age to determine whether geriatric patients respond differently than younger adults. For fluconazole-refractory esophageal candidiasis, IDSA recommends itraconazole oral solution or IV or oral voriconazole; alternatives are an IV echinocandin (anidulafungin, caspofungin, micafungin) or IV amphotericin B. IDSA states oral posaconazole (oral suspension or delayed-release tablets) is another possible alternative for treatment of fluconazole-refractory esophageal candidiasis. (See Actions and Spectrum.). For treatment of chorioretinitis (with or without vitritis) caused by Candida, IDSA recommends fluconazole or voriconazole when isolates are susceptible and amphotericin B (with or without oral flucytosine) when isolates are resistant to fluconazole and voriconazole; intravitreal amphotericin B or voriconazole may also be indicated. I am a U.S. Up to 400 mg once daily may be used depending on the patients response. Low birthweight neonates (<1 kg) at high risk: AAP recommends an initial dose of 3 mg/kg IV during first 4872 hours after birth, followed by 3 mg/kg IV twice weekly for 46 weeks or until IV access no longer required for care. Alternative for treatment of histoplasmosis caused by Histoplasma capsulatum. Usually used as follow-up after an initial regimen of IV amphotericin B or in conjunction with IV amphotericin B. HIV-infected adults or other adults: 400800 mg daily. Although routine long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent relapse or recurrence not usually recommended in patients adequately treated for oropharyngeal candidiasis (including HIV-infected individuals), patients with frequent or severe recurrences of esophageal candidiasis may benefit from secondary prophylaxis with oral fluconazole or posaconazole oral suspension; however, consider potential for development of azole resistance. Consider transition from the echinocandin to fluconazole (usually within 57 days) in clinically stable patients if strain susceptible to fluconazole (e.g., C. albicans) and initial treatment resulted in negative repeat blood cultures. CanesOral; Descriptions. Tinea corporis involving small, well-defined lesions: 250 mg once weekly for 24 weeks has been recommended. Shake suspension well just prior to administration of each dose. This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions. Angioedema and anaphylactic reactions have been reported rarely in women who received a single oral dose for treatment of vulvovaginal candidiasis. Description and Brand Names. (See Cautions.). Avoid alcoholic drinks. HIV-infected adults with less severe disease: 800 mg daily. FDA alerted clinicians in April 2016 that it is reviewing safety data regarding use of oral fluconazole during pregnancy and advised cautious prescribing of the drug until the review is completed. You may report side effects to FDA at 1-800-FDA-1088. Fluconazole is a white crystalline solid which is slightly soluble in water and saline. Fluconazole is an alternative for initial therapy in those who are not critically ill and have had no prior exposure to azole antifungals; also can be used for step-down therapy in clinically stable patients who have fluconazole-susceptible isolates and negative repeat blood cultures. Prolonged or intermittent use of oral fluconazole in immunocompromised patients has been suggested as a major contributing factor to emergence of fluconazole resistance in Candida. Candida and C. neoformans with decreased in susceptibility to fluconazole have been reported. Inhibits CYP 14--desmethylase in susceptible fungi, which leads to accumulation of C-14 methylated sterols (e.g., lanosterol) and decreased concentrations of ergosterol. HIV-infected adults who cannot receive amphotericin B: Induction therapy with oral or IV fluconazole 400800 mg daily and oral flucytosine given for at least 46 weeks, then consolidation therapy with oral fluconazole 400 mg daily given for at least 8 weeks. Plasma concentrations are higher and half-life prolonged. Administration with a high-fat meal does not affect fluconazole peak plasma concentrations or AUC compared with administration in the fasting state. Cleveland Clinic is a non-profit academic medical center. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, An unusual or allergic reaction to fluconazole, other azole antifungals, medications, foods, dyes, or preservatives, Other medications that prolong the QT interval (cause an abnormal heart rhythm), Certain antibiotics like rifabutin, rifampin, Certain medications for blood pressure, heart disease, irregular heartbeat, Certain medications for cholesterol like atorvastatin, lovastatin, and simvastatin, Certain medications for depression, like amitriptyline, nortriptyline, Certain medications for diabetes like glipizide or glyburide, Certain medications for seizures like carbamazepine, phenytoin, Certain medications that treat or prevent blood clots like warfarin, Certain narcotic medications for pain like alfentanil, fentanyl, methadone, NSAIDS, medications for pain and inflammation, like ibuprofen or naproxen, Allergic reactionsskin rash, itching, hives, swelling of the face, lips, tongue, or throat, Heart rhythm changesfast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing, Liver injuryright upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue, Low adrenal gland functionnausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness, Redness, blistering, peeling, or loosening of the skin, including inside the mouth. HIV-infected infants and children: 612 mg/kg (up to 400 mg) once daily for 714 days. IV infusions should be administered at a rate 200 mg/hour. For refractory esophageal candidiasis, including fluconazole-refractory infections, in HIV-infected adults and adolescents, itraconazole oral solution or posaconazole oral suspension is recommended; alternatives are IV amphotericin B, an IV echinocandin (anidulafungin, caspofungin, micafungin), or oral or IV voriconazole. Moderate or severe oropharyngeal candidiasis: IDSA recommends 100200 mg daily for 714 days. Superinfection with nonsusceptible fungi (e.g., C. krusei) may occur; alternative antifungal therapy may be required. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Fluconazole - How long does it take to work? Dosage may be increased up to 12 mg/kg daily if necessary, based on response and condition of the patient. Consult current IDSA clinical practice guidelines available at [Web] and current CDC, NIH, and IDSA clinical practice guidelines for prevention and treatment of opportunistic infections in HIV-infected individuals available at [Web] for additional information on management of oropharyngeal candidiasis. Consider discontinuing secondary prophylaxis against histoplasmosis in HIV-infected adults who have received such prophylaxis for 1 year, have negative fungal blood cultures and serum histoplasma antigen levels <2 ng/mL, have been receiving antiretroviral therapy for 6 months, and have CD4+ T-cell counts 150/mm3. Alternatives for systemic treatment are itraconazole oral solution or posaconazole oral suspension; nystatin oral suspension is an alternative for topical treatment. Further dosage adjustments may be necessary depending on patient condition. Do not use oral azoles for initial treatment of CNS blastomycosis. Various dosage regimens have been used for prophylaxis to reduce the incidence of invasive candidiasis in low birthweight neonates at high risk. Some clinicians recommend 150 mg once weekly for 46 weeks. Fluconazole is used to treat serious fungal or yeast infections, including vaginal candidiasis, oropharyngeal candidiasis (thrush, oral thrush), esophageal candidiasis (candida esophagitis), other candida infections (including urinary tract infections, peritonitis [inflammation of the lining of the stomach], and infections that may occur in diff. While hepatotoxicity usually has been reversible, fatalities have occurred, principally in patients with serious underlying disease (e.g., AIDS, malignancy) who were receiving other drugs concomitantly. FDA is reviewing data from the Danish study and additional data; after completing the review, FDA will communicate its conclusions and updated recommendations regarding use of the single-dose 150-mg oral fluconazole regimen during pregnancy. Antifungal prophylaxis not usually recommended if anticipated duration of neutropenia is <7 days. Use of fluconazole or itraconazole alone may be sufficient for treatment of mild coccidioidomycosis in HIV-infected infants and children with only mild disease (e.g., focal pneumonia) and also can be considered an alternative for those with stable pulmonary or disseminated coccidioidomycosis (nonmeningeal). If you are taking this medication for a long time you may need blood work. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information. Congenital abnormalities reported in infants born to women who received high-dose fluconazole (400800 mg daily) for treatment of serious, life-threatening fungal infections during most or all of the first trimester. Immunocompetent or immunocompromised adults with severe pulmonary cryptococcosis, cryptococcemia, or disseminated cryptococcosis: Use regimens recommended for adults with cryptococcal meningitis. If abnormal liver function test results occur, monitor patient for the development of more severe hepatic injury. For fluconazole-refractory oropharyngeal candidiasis, IDSA recommends itraconazole oral solution or posaconazole oral suspension; oral voriconazole or amphotericin B oral suspension (not commercially available in US) recommended as alternatives. HIV-infected adolescents who cannot receive amphotericin B: Induction therapy with oral or IV fluconazole 400800 mg daily and oral flucytosine given for at least 46 weeks, then consolidation therapy with oral fluconazole 400 mg daily given for at least 8 weeks. Does fluconazole flush out yeast/discharge? It belongs to a class of drugs called azole antifungals. Approximately 6080% of a single oral or IV dose excreted in urine unchanged; about 11% is excreted in urine as metabolites. Drug information provided by: Merative, Micromedex US Brand Name. Most reported cases involved seriously ill patients with multiple confounding risk factors that may have contributed (e.g., structural heart disease, electrolyte abnormalities, concomitant drugs). (See Renal Impairment under Dosage and Administration.). For treatment of osteoarticular infections (e.g., osteomyelitis, septic arthritis) caused by Candida, IDSA recommends initial treatment with fluconazole or an IV echinocandin (anidulafungin, caspofungin, micafungin) and follow-up treatment with fluconazole. For treatment of uncomplicated vulvovaginal candidiasis (mild to moderate, sporadic or infrequent, most likely caused by C. albicans, occurring in immunocompetent women) in nonpregnant women, CDC and others recommend a topical (intravaginal) azole antifungal (e.g., butoconazole, clotrimazole, miconazole, terconazole, tioconazole) given in appropriate single-dose or short-course (13 days) regimen or, alternatively, single-dose regimen of oral fluconazole. If induction regimen does not include flucytosine, continue for at least 46 weeks. Alcohol can increase possible damage to your liver. May be active in vitro against some strains of C. gattii, but there is in vitro evidence that fluconazole may be less active against C. gattii than some other azoles (e.g., itraconazole, posaconazole, voriconazole). In adults and children who do not have HIV infection and are not transplant recipients, the preferred regimen for treatment of cryptococcal meningitis is induction therapy with IV amphotericin B given in conjunction with oral flucytosine for at least 4 weeks (a 2-week induction period can be considered in those who are immunocompetent, are without uncontrolled underlying disease, and are at low risk for therapeutic failure), then consolidation therapy with oral fluconazole administered for an additional 8 weeks or longer. Treatment of onychomycosis of toenails or fingernails. Adults with impaired renal function receiving single-dose regimen for treatment of vulvovaginal candidiasis: Modification of dosage not needed. 36 mg/kg daily for 26 weeks has been effective in children 1.516 years of age. Manufacturer recommends 12 mg/kg on the first day, then 6 mg/kg once daily. Manufacturer recommends an initial loading dose of 50400 mg (based on the type of infection being treated), then give 100% of the usual daily dose to those with Clcr >50 mL/minute and give 50% of the usual daily dose to those with Clcr 50 mL/minute. A drug of choice. Initiate on the day of HSCT transplantation (i.e., day 0) and continue until engraftment occurs (i.e., approximately 30 days after HSCT) or until 7 days after neutrophil count is >1000/mm3. Follow the directions on the prescription label. Although routine long-term suppressive or maintenance therapy (secondary prophylaxis) to prevent relapse or recurrence not usually recommended in patients adequately treated for oropharyngeal candidiasis (including HIV-infected individuals), patients with frequent or severe recurrences of oropharyngeal candidiasis may benefit from secondary prophylaxis with oral fluconazole; however, consider potential for development of azole resistance. 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