Release forms Diflucan
Capsules 50 mg, 100 mg № 7, 150 mg № 1
Solution for infusion (2 mg / ml) for 50 ml, 100 ml in bottles number 1
Who can diflucan?
Cryptococcosis, including cryptococcal meningitis and other localization of the infection (including lung, skin), both in patients with normal immune response, and patients with various forms of immunosuppression (including AIDS patients, organ transplants ) prophylaxis of cryptococcal infection in AIDS patients; generalized candidiasis, including candidemia, disseminated candidiasis and other forms of invasive Candida infections (infections of the peritoneum, endocardium, eyes, respiratory and urinary tract). Treatment can be performed in patients with malignancies, patients in intensive care, patients undergoing cytotoxic or immunosuppressive therapy, as well as the presence of other factors predisposing to candidiasis, mucosal candidiasis, including oral cavity and pharynx (including atrophic oral candidiasis associated with wearing dentures), esophagus, non-invasive bronchopulmonary candidiasis, candiduria, candidiasis skin, prevention of relapse of oropharyngeal candidiasis in patients with AIDS, genital candidiasis: vaginal candidiasis (acute and chronic recurrent), prophylactic use to reduce the recurrence of vaginal candidiasis (3 or more episodes per year), candidal balanitis, prevention of fungal infections in patients with malignancies who are predisposed to such infections as a result of chemotherapy, cytotoxic drugs or radiation therapy, skin fungal infections, including athlete’s foot, body, groin, pityriasis versicolor, onychomycosis;
candidiasis skin deep endemic mycoses, including coccidioidomycosis, paracoccidioidomycosis, sporotrichosis and histoplasmosis in patients with normal immunity.
How do I use Diflucan?
In cryptococcal meningitis and cryptococcal infections at other sites for adults on the first day is usually 400 mg, and then continue treatment at a dose of 200-400 mg 1 time per day.
Duration of treatment for cryptococcal infection depends on clinical efficacy, confirmed by mycological examination, with cryptococcal meningitis is usually continued for at least 6-8 weeks.
For the prevention of relapse of cryptococcal meningitis in AIDS patients after completion of a full course of primary therapy, fluconazole is prescribed in doses of 200 mg / day for a long period of time.
When candidemia, disseminated candidiasis and other invasive Candida infections, the dose usually is the first day 400 mg, and then – 200 mg. In case of insufficient clinical efficacy of the drug dose may be increased to 400 mg / day. Duration of therapy depends on clinical effectiveness.
If oropharyngeal candidiasis, the drug is usually prescribed for 50-100 mg 1 time a day, treatment duration – 7-14 days. If necessary, patients with a marked decrease in immune treatment may be longer.
When atrophic oral candidiasis associated with wearing dentures, fluconazole is usually prescribed at 50 mg 1 every day for 14 days in conjunction with local antiseptic treatment prosthesis.
At other sites candidiasis (excluding genital), such as esophagitis, non-invasive bronchopulmonary defeat candiduria, candidiasis of the skin and mucous membranes, etc. effective dose is usually 50-100 mg / day for the duration of treatment 14-30 days.
To prevent a recurrence of oropharyngeal candidiasis in patients with AIDS after completing the full course of primary care medicine can be assigned to 150 mg 1 time per week.
Vaginal candidiasis fluconazole taking a single dose oral dose of 150 mg. To reduce the recurrence of vaginal candidiasis drug may be used at a dose of 150 mg 1 time per month. The duration of therapy is determined individually, it varies from 4 to 12 months. Some patients may require more frequent applications.
When balanitis caused by Candida, fluconazole prescribed single dose of 150 mg inside.
For the prevention of candidiasis is the recommended dose fluconazole 50-400 mg 1 time a day, depending on the degree of risk of fungal infection. If there is a high risk of generalized infection, such as patients with expected severe or long-lasting neutropenia, the recommended dose is 400 mg 1 time per day. Fluconazole prescribed for a few days before the expected occurrence of neutropenia, after the increase in the number of neutrophils over 1000/mm3 treatment continued for 7 days.
If mycosis of skin, including athlete’s foot, skin, groin, and skin candidiasis The recommended dose is 150 mg 1 time a week or 50 mg 1 time per day. The duration of therapy in ordinary cases is 2-4 weeks, but the athlete’s foot may require more prolonged therapy (up to 6 weeks).
When chromophytosis – 300 mg 1 time a week for 2 weeks, some patients required a third dose – 300 mg per week, while in some cases it is sufficient to single dose of 300-400 mg; alternative regimen is the use of 50 mg 1 times a day for 2-4 weeks.
When onychomycosis the recommended dose is 150 mg 1 time per week. Treatment should continue until replacement of the infected nail (Sprouting uninfected nail). To re-growth of the fingernails and feet in the required rate of 3-6 and 6-12 months respectively.
With deep endemic mycoses may be required to use the drug at a dose of 200-400 mg / day for up to 2 years. The duration of therapy is determined individually, and it can be 11-24 months – with coccidioidomycosis, 2-17 months – with paracoccidioidomycosis; 1-16 months – with sporotrichosis, and 3-17 months – with histoplasmosis.
In children, as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. In children, the drug should not be used in a daily dose that would exceed those of adults. The drug is used daily, 1 time per day.
When mucosal candidiasis recommended dose fluconazole at 3 mg / kg / day. On the first day may be imposed loading dose (6 mg / kg) to more rapidly achieve constant equilibrium concentration.
For the treatment of generalized candidiasis or cryptococcal infection the recommended dose is 6-12 mg / kg / day depending on the severity of the disease.
To prevent fungal infections in children with reduced immunity, where the risk of infection associated with neutropenia, which develops as a result of cytotoxic chemotherapy or radiation therapy, a drug prescribed by 3-12 mg / kg / day depending on the severity and duration of preservation-induced neutropenia.
In children with impaired renal function the daily dose should be reduced (in the same proportional relationship as that of adults), in accordance with the degree of severity of renal failure.
In elderly patients without renal dysfunction should follow the usual dosage regimen of the drug. Patients with renal impairment (Cl creatinine <50 ml / min) dosing regimen should be adjusted as indicated below. Use of the drug in patients with impaired renal function Fluconazole is derived mainly from the urine in unchanged form. For a single admission changed its dose is not required. With the reappointment of the drug to patients with impaired renal function should first introduce a loading dose – 50-400 mg. If Cl creatinine> 50 ml / min, applied the usual dose (100% of recommended dose). When creatinine Cl 11-50 ml / min is applied dose equal to 50% of recommended. Patients who regularly are on dialysis, one dose of the drug is applied after each hemodialysis session.
Side effects of Diflucan
From the digestive system: nausea, diarrhea, flatulence, abdominal pain, rarely – liver dysfunction (hyperbilirubinemia, increased ALT, AST, increased activity of ALP).
The nervous system: headache, rarely – seizures.
On the part of hematopoiesis: rarely – leukopenia, thrombocytopenia, neutropenia, agranulocytosis.
Allergic reactions: skin rash, rarely – malignant exudative erythema (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell’s syndrome), anaphylactoid reactions.
Other: rarely – renal failure, alopecia, hypercholesterolemia, hypertriglyceridemia, hypokalemia.
Who contraindications diflucan?
Hypersensitivity to the drug or close in structure to azole compounds, simultaneous use of terfenadine, astemizole and other drugs that prolong the interval QT; pregnancy, lactation, childhood (up to 6 months).
Interaction Diflucan
In the application of fluconazole with warfarin increases MF (on average 12%). In this regard, should carefully monitor the parameters of MF patients receiving the drug in combination with coumarin anticoagulants.
Fluconazole increases the T1 / 2 from the plasma of oral hypoglycemic agents – sulfonylureas (chlorpropamide, glibenclamide, glipizide, tolbutamide) in healthy people. Joint application of fluconazole and oral hypoglycemic agents in diabetic patients is allowed, but the physician should bear in mind the possibility of hypoglycemia.
Concomitant use of fluconazole and phenytoin may lead to an increase in plasma concentration of phenytoin to a clinically significant degree. Therefore, when the need for joint use of these drugs need to monitor the concentration of phenytoin with the correction of the dose to maintain the level of the drug within the therapeutic range.
Combination with rifampicin reduces the AUC by 25% and a shortening of T1 / 2 of fluconazole from plasma by 20%. Therefore, patients receiving both rifampin, the dose of fluconazole is expedient to increase.
It is recommended to monitor the concentration of cyclosporine in the blood of patients treated with fluconazole, because the application of fluconazole and cyclosporine in patients with renal transplant recipients, receiving fluconazole at a dose of 200 mg / day leads to a slow increase in the concentration of cyclosporine in plasma.
Patients who receive high doses of theophylline or who have a chance of developing teofillinovoy intoxication should be kept under observation for early detection of symptoms of an overdose of theophylline, as receiving fluconazole leads to a decrease in the average clearance rate of theophylline from plasma.
With the simultaneous application of fluconazole and cisapride been described adverse reactions from the heart, including ventricular tachycardia (torsades de points).
There have been reports about the interaction of fluconazole and rifabutin, leading to enhanced serum levels of the latter.
With the simultaneous application of fluconazole and rifabutin describes cases of uveitis. Need to carefully observe patients while receiving rifabutin and fluconazole.
In patients receiving the combination of fluconazole and zidovudine, an increase of concentration of zidovudine, which is due to decreased conversion of the latter into its main metabolite, so you should expect an increase in side effects of zidovudine ..
Diflucan Overdose
Symptoms: hallucinations, paranoid behavior.
Treatment: symptomatic, gastric lavage, forced diuresis. Hemodialysis for 3 h reduces the plasma concentration of approximately 50%.
