Indications

Fluconal (Fluconazole) is an azole antifungal medication indicated for the treatment and prevention of various fungal infections, including:

• Candidal infections: Vaginal, oropharyngeal, and esophageal candidiasis, as well as invasive and systemic candidiasis.
• Tinea infections:Tinea corporis, tinea cruris, tinea pedis, and Pityriasis versicolor.
• Other infections: Kerion, onychomycosis, cryptococcal infections (including meningitis), fungal urinary tract infections, coccidioidomycosis, and histoplasmosis.
• Prophylaxis: Prevention of cryptococcal meningitis and fungal infections in immunocompromised patients, including neutropenic cancer patients.

Pharmacology

Fluconazole is a triazole antifungal agent that works by inhibiting fungal cytochrome P-450 dependent enzymes. This enzyme system is essential for the synthesis of ergosterol, a crucial component of the fungal cell membrane. By inhibiting this process, Fluconazole leads to the death of the fungal cell.

Dosage & Administration

• Adults:
  • Vaginal Candidiasis: 150 mg as a single dose.
  • Oropharyngeal Candidiasis: 200 mg on day 1, then 100 mg daily for 14 days.
  • Systemic/Invasive Infections: 400 mg on day 1, then 200-400 mg daily.
  • Tinea Infections: Doses and durations vary. For example, Tinea corporis is 150 mg weekly for 4-6 weeks.
• Children (over 1 year):
  • Superficial Candidiasis: 1-2 mg/kg daily.
  • Systemic/Invasive Infections: 3-6 mg/kg daily. Doses up to 12 mg/kg daily (max 400 mg) have been used for serious infections in children aged 5-13.
• Renal Impairment: No dose adjustment is needed for single-dose therapy. For multiple-dose therapy, the dosage interval should be adjusted based on creatinine clearance. For example, a creatinine clearance of 21-40 ml/min requires a 48-hour dosage interval.

Interaction

• Anticoagulants (Warfarin): May increase prothrombin time; careful monitoring is recommended.
• Oral Sulfonylureas: May prolong their half-life, potentially causing hypoglycemia.
• Hydrochlorothiazide: Increases fluconazole plasma concentrations.
• Phenytoin: May increase phenytoin levels to a clinically significant degree.
• Rifampicin: Decreases fluconazole's half-life and AUC; an increase in the fluconazole dose may be necessary.
• Theophylline: May decrease the clearance of theophylline; monitor for signs of toxicity.
• Cyclosporin: May slowly increase cyclosporin concentrations; monitoring is recommended.

Contraindications

Fluconazole should not be used in patients with a known hypersensitivity to Fluconazole or other related triazole compounds.

Side Effects

Fluconal is generally well-tolerated. The most common side effects are gastrointestinal, including nausea, abdominal discomfort, diarrhea, and flatulence. Other side effects such as rash are rare.

Pregnancy & Lactation

• Pregnancy: Adverse fetal effects have been observed in animals at high doses. It should not be used in pregnant women or women of child-bearing potential unless adequate contraception is employed.
• Lactation: Fluconazole is found in breast milk at concentrations similar to plasma, so its use in nursing mothers is not recommended.

Precautions & Warnings

• Hepatic/Renal Function: Abnormalities in liver and renal function tests have been observed, particularly in seriously ill patients. The risk-benefit ratio should be assessed if a significant rise in liver enzymes occurs.
• Skin Reactions: Rarely, patients may develop severe exfoliative cutaneous reactions such as Stevens-Johnson Syndrome. Discontinue the drug if a rash develops.

Overdose Effects

In the event of an overdose, supportive measures and symptomatic treatment, including gastric lavage, are recommended. Hemodialysis can reduce plasma levels by approximately 50%.

Therapeutic Class

Fluconal is a drug for subcutaneous and mycoses.

Storage Conditions

Keep in a dry place, away from light and heat. Keep out of the reach of children.