Fluconazole

About Fluconazole

Fluconazole is a triazole that slows the growth of fungi. The label covers vaginal yeast infections due to Candida, oropharyngeal (thrush) and esophageal candidiasis, Candida urinary tract infections, peritonitis and systemic infections such as candidemia, cryptococcal meningitis, and prevention of candidiasis in people having a bone marrow transplant with chemotherapy or radiation. For a vaginal yeast infection the dose is one 150 mg tablet. Thrush is treated with 200 mg on the first day, then 100 mg once a day for at least 2 weeks; esophageal candidiasis for at least 3 weeks and 2 weeks after symptoms end; cryptococcal meningitis with 400 mg on the first day, then 200 mg a day for 10 to 12 weeks after the spinal fluid culture turns negative. Children are dosed by weight, and a trial showed it effective for thrush in children 6 months to 13 years. Taking it weekly to prevent repeated yeast infections is not an FDA-approved use, and the prescriber decides.

There is no boxed warning. Rare serious liver injury, including deaths mainly in people with serious underlying illness, has been reported; abnormal liver tests are monitored, and fluconazole is stopped if signs of liver disease develop. Anaphylaxis and exfoliative skin reactions have occurred, and someone treated for a superficial fungal infection stops it if a rash appears. Rare QT prolongation and torsade de pointes have been reported, mostly in seriously ill people; low potassium and advanced heart failure raise the risk. It must not be taken with erythromycin, pimozide, quinidine or other QT-prolonging drugs broken down by the CYP3A4 enzyme, and adrenal insufficiency has been reported. With the single 150 mg dose, headache, nausea and abdominal pain were the most common side effects.

Fluconazole is a moderate CYP2C9 and CYP3A4 inhibitor and a strong CYP2C19 inhibitor, and the label says this persists 4 to 5 days after the last dose, so interactions can outlast a short course. The label says use in pregnancy should be avoided except for severe or potentially life-threatening fungal infections, when the expected benefit outweighs the possible risk to the fetus. Case reports describe a distinct pattern of birth defects after high doses (400 to 800 mg a day) through most or all of the first trimester, and epidemiological studies suggest a potential risk of miscarriage and birth defects with 150 mg taken once or repeatedly in the first trimester, though these studies have limitations and the findings have not been confirmed in controlled trials. For women who could become pregnant and take 400 to 800 mg a day, effective contraception is considered during treatment and for about a week after the last dose. Low levels reach breast milk after a 150 mg dose, and the label advises caution while breastfeeding. It also says the convenience of the single tablet should be weighed against more drug-related side effects than with vaginal treatments.

Taking Fluconazole

How to take it

Once a day, with or without food; a vaginal yeast infection is usually treated with one 150 mg tablet. Shake the suspension well before each dose. For longer courses, keep taking it until the prescriber says to stop, even if you feel better.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

Tablets below 86°F (30°C), out of reach of children. Keep the mixed suspension between 41°F and 86°F (5°C and 30°C), do not freeze it, and throw away what is left after 2 weeks.

Interactions to know about

Erythromycin, pimozide and quinidine must not be taken with it. It can raise the levels or effects of warfarin, sulfonylureas such as glyburide, phenytoin, statins such as atorvastatin and simvastatin (raising the risk of muscle injury), methadone, tofacitinib and many others, and rifampin speeds its breakdown.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Fluconazole differs from pharmacy to pharmacy

Generic fluconazole tablets come from several makers, so quotes for the same prescription differ by each pharmacy’s dispensing fee and markup and by whether fluconazole is on its flat-price generic list. A single 150 mg tablet and a course lasting weeks are very different quantities, so each prescription is quoted as written.

The suspension has fewer makers than the tablets and is quoted by strength and bottle. A prescription that names Diflucan and blocks substitution is filled with the brand.

Ways to pay less for Fluconazole without insurance

• Ask whether fluconazole is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If the prescription names Diflucan, check that it allows a generic.
• For a child’s suspension, confirm the strength and how many bottles the course needs, so the quote covers all of it.
• If an older child can swallow tablets, ask the prescriber whether tablets would suit instead of the liquid.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Fluconazole

1. 1.Does fluconazole interact with my statin, blood thinner or diabetes medicine?
2. 2.Do my heart rhythm, potassium level or other medicines make it risky for me?
3. 3.How soon should my symptoms improve, and when should I call?
4. 4.Is it safe if I am pregnant or could become pregnant?

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