Diflucan (fluconazole) is a systemic antifungal medication indicated for the treatment and prevention of various fungal infections. As a triazole antifungal agent, it works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes, leading to cell death. This medication is available in oral and intravenous formulations, providing flexibility in administration based on clinical need and patient condition. Healthcare professionals prescribe Diflucan for its broad-spectrum activity against Candida species and Cryptococcus neoformans.

Features

• Active ingredient: Fluconazole 50 mg, 100 mg, 150 mg, or 200 mg tablets
• Available formulations: Oral tablets, oral suspension, and intravenous solution
• Mechanism of action: Inhibition of fungal cytochrome P450-dependent 14α-demethylase
• Spectrum of activity: Effective against Candida albicans, Candida tropicalis, Candida parapsilosis, and Cryptococcus neoformans
• Bioavailability: Approximately 90% following oral administration
• Half-life: Approximately 30 hours, allowing for once-daily dosing

Benefits

• Provides rapid symptomatic relief from fungal infections within 24-72 hours of initiation
• Demonstrates excellent tissue penetration, including central nervous system and urinary tract
• Offers convenient once-daily dosing regimen for improved patient compliance
• Shows predictable pharmacokinetics with minimal interpatient variability
• Presents favorable safety profile compared to older antifungal agents
• Available in multiple formulations to accommodate various patient needs

Common use

Diflucan is commonly prescribed for the treatment of oropharyngeal and esophageal candidiasis. It is also indicated for systemic candidiasis, including candidemia, disseminated candidiasis, and peritonitis. The medication serves as first-line therapy for cryptococcal meningitis and is used for prophylaxis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy and/or radiation therapy. Additionally, healthcare providers may prescribe Diflucan for vaginal candidiasis, particularly in cases of recurrent infection.

Dosage and direction

The recommended dosage of Diflucan varies according to the infection being treated. For oropharyngeal candidiasis, 200 mg on the first day followed by 100 mg once daily for at least 2 weeks. Esophageal candidiasis requires 200 mg on the first day followed by 100 mg once daily for a minimum of 3 weeks. Systemic candidiasis typically necessitates 400 mg on the first day followed by 200 mg once daily. Cryptococcal meningitis treatment involves 400 mg on the first day followed by 200-400 mg once daily for 10-12 weeks after cerebrospinal fluid becomes culture-negative. Administration should occur at approximately the same time each day, with or without food.

Precautions

Patients with impaired renal function require dosage adjustment based on creatinine clearance. Hepatic function should be monitored during prolonged therapy. Electrolyte disturbances, particularly hypokalemia, should be corrected before initiating therapy. Caution is advised in patients with potentially proarrhythmic conditions. Healthcare providers should monitor for development of exfoliative skin disorders during treatment. Patients should be advised that dizziness may occur and to exercise caution when operating machinery or driving.

Contraindications

Diflucan is contraindicated in patients with known hypersensitivity to fluconazole or any component of the formulation. Coadministration with cisapride is contraindicated due to the potential for serious cardiovascular adverse events. The medication is contraindicated in patients taking drugs that prolong the QT interval and are metabolized by CYP3A4, such as terfenadine, astemizole, and erythromycin. Use is contraindicated in breastfeeding infants due to secretion in human milk.

Possible side effect

Common adverse reactions include headache (13%), nausea (7%), abdominal pain (6%), diarrhea (3%), and dyspepsia (1%). Skin rash develops in approximately 2% of patients. Less frequent side effects include vomiting, dizziness, and taste perversion. Hepatic enzyme elevations may occur in 1-3% of patients. Serious but rare adverse effects include hepatotoxicity, anaphylaxis, QT prolongation, and exfoliative skin disorders. Alopecia has been reported in some patients receiving long-term therapy.

Drug interaction

Diflucan significantly inhibits CYP2C9 and CYP3A4 enzymes, leading to numerous potential drug interactions. It increases concentrations of warfarin, phenytoin, cyclosporine, and statins. Coadministration with rifampin decreases fluconazole concentrations by approximately 25%. Hydrochlorothiazide increases fluconazole concentrations by approximately 40%. The medication potentiates effects of sulfonylurea drugs, requiring blood glucose monitoring. Concurrent use with other QT-prolonging agents may increase the risk of cardiac arrhythmias.

Missed dose

If a dose is missed, patients should take it as soon as they remember unless it is nearly time for the next scheduled dose. In such cases, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Healthcare providers should educate patients about the importance of maintaining the prescribed dosing schedule to ensure optimal therapeutic outcomes.

Overdose

Symptoms of overdose may include hallucinations and paranoid behavior. In cases of suspected overdose, symptomatic and supportive treatment should be instituted. Gastric lavage may be beneficial if performed soon after ingestion. As fluconazole is largely excreted in urine, forced diuresis would likely enhance elimination. Hemodialysis for three hours reduces plasma concentrations by approximately 50%. There is no specific antidote for fluconazole overdose.

Storage

Store Diflucan tablets at controlled room temperature 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep the medication in its original container, tightly closed, and protected from moisture and light. Oral suspension should be stored between 5°C and 30°C (41°F and 86°F) and discarded within 14 days after reconstitution. Keep all medications out of reach of children and pets.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Healthcare professionals should consult the full prescribing information before initiating therapy. Patients should not make changes to their medication regimen without consulting their healthcare provider. The efficacy and safety information provided is based on clinical trial data and may not reflect individual patient experiences.

Reviews

Clinical studies demonstrate Diflucan’s efficacy with mycological cure rates of 80-90% in oropharyngeal candidiasis and 85% in esophageal candidiasis. In cryptococcal meningitis trials, success rates of 60-70% were observed. Patient satisfaction surveys indicate high levels of satisfaction with the convenience of once-daily dosing. Healthcare providers report positive experiences with the medication’s predictable pharmacokinetics and generally favorable safety profile. Long-term follow-up studies show maintained efficacy in prophylaxis settings with appropriate monitoring.