II. Indications

  1. Onychomycosis
  2. Yeast Vaginitis (Single dose)

III. Dosing

  1. Tinea Capitis
    1. Daily: 6 mg/kg/day (up to 150 mg to 300 mg) daily for 3 to 6 weeks
    2. Weekly: 6 mg/kg/day (up to 150 mg to 300 mg) weekly for 8 to 12 weeks
  2. Onychomycosis
    1. Adult: 150 to 300 mg (up to 450 mg) orally once per week
    2. Child: 3 to 6 mg/kg once weekly
    3. Course
      1. Fingernail: 3-6 months
      2. Toenail: 6-12 months
  3. Yeast Vaginitis
    1. Adult dose: 150 mg PO for 1 dose

IV. Monitoring

  1. Onychomycosis or Yeast Vaginitis
    1. No routine lab tests recommended
  2. Some guidelines have recommended baseline labs
    1. Complete Blood Count (CBC)
    2. Liver transaminases (AST, ALT)
    3. Serum Creatinine

V. Adverse effects (5% of patients)

VI. Drug interactions

  1. Absorption not affected by gastric pH
  2. Significant Sedation with Benzodiazepines
  3. Cimetidine decreases Fluconazole levels
  4. Hydrochlorothiazide increases Fluconazole levels
  5. Rifampin decreases Fluconazole levels
  6. Oral Hypoglycemics (e.g. Sulfonylureas)
    1. Risk of Hypoglycemia
  7. Fluconazole increases Theophylline levels
  8. Increased bleeding risk with Warfarin

VII. Precautions

  1. As of 2016, evidence of Miscarriage risk, with even 1-2 doses
    1. Previously thought safe in pregnancy if limited to occassional single dose
    2. Mølgaard-Nielsen (2016) JAMA 315(1):58-67 +PMID:26746458 [PubMed]

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Cost: Medications

Fluconazole (on 6/18/2017 at Walmart.com)
Fluconazole 150mg #1 tablet for $4.00 $4.00 each
Fluconazole 150mg #3 tablets for $10.00 $3.33 each
fluconazole (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FLUCONAZOLE 10 MG/ML SUSP Generic $0.31 per ml
FLUCONAZOLE 100 MG TABLET Generic $1.06 each
FLUCONAZOLE 150 MG TABLET Generic $1.67 each
FLUCONAZOLE 200 MG TABLET Generic $1.47 each
FLUCONAZOLE 40 MG/ML SUSP Generic $0.79 per ml
FLUCONAZOLE 50 MG TABLET Generic $1.05 each
diflucan (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DIFLUCAN 150 MG TABLET Generic $1.67 each

Ontology: Fluconazole (C0016277)

Definition (CHV) a kind of antifungal drug
Definition (NCI_NCI-GLOSS) A drug that treats infections caused by fungi.
Definition (NCI) A synthetic triazole with antifungal activity. Fluconazole preferentially inhibits fungal cytochrome P-450 sterol C-14 alpha-demethylation, resulting in the accumulation of fungal 14 alpha-methyl sterols, the loss of normal fungal sterols, and fungistatic activity. Mammalian cell demethylation is much less sensitive to fluconazole inhibition.
Definition (MSH) Triazole antifungal agent that is used to treat oropharyngeal CANDIDIASIS and cryptococcal MENINGITIS in AIDS.
Definition (CSP) alpha-(2,4-difluorophenyl)-alpha- (1,2,4-triazol-1-ylmethyl)-1,2, 4- triazole-1-ethanol; an antifungal with potential efficacy for patients unable to take amphotericin B or who are immunologically compromised, as in AIDS.
Definition (PDQ) A synthetic triazole with antifungal activity. Fluconazole preferentially inhibits fungal cytochrome P-450 sterol C-14 alpha-demethylation, resulting in the accumulation of fungal 14 alpha-methyl sterols, the loss of normal fungal sterols, and fungistatic activity. Mammalian cell demethylation is much less sensitive to fluconazole inhibition. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40842&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40842&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C500" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D015725
SnomedCT 31865003, 387174006
LNC LP14993-7, MTHU002296
English 1H-1,2,4-Triazole-1-ethanol, alpha-(2,4-difluorophenyl)-alpha-(1H-1,2,4-triazol-1-ylmethyl)-, alpha-(2,4-difluorophenyl)-alpha- (1,2,4-triazol-1-ylmethyl)-1,2, 4- triazole-1-ethanol, fluconazole, FLUCONAZOLE, Fluconazole, fluconazole (medication), Fluconazole [Chemical/Ingredient], Fluconazole product, Fluconazole (product), Fluconazole (substance), FCZ
Swedish Flukonazol
Czech flukonazol
Finnish Flukonatsoli
Russian FLUKONAZOL, ФЛУКОНАЗОЛ
Japanese フルコナゾール
Polish Flukonazol
Spanish fluconazol (producto), fluconazol (sustancia), fluconazol, Fluconazol
French Fluconazole
German Fluconazol
Italian Fluconazolo
Portuguese Fluconazol

Ontology: Diflucan (C0699601)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D015725
English diflucan, Diflucan, Pfizer Brand of Fluconazole, Triflucan