Fluconazole therapy

Discussion in 'Pharmacy Tech' started by Morix, 26-Aug-2019.

  1. Ingwar New Member

    Fluconazole therapy


    Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than , frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. QT prolongation Torsades de pointes Alopecia Anaphylactic reactions Angioedema Cholestasis Dizziness Dyspnea Hepatic failure Hepatitis Hypertriglyceridemia Hypokalemia Increased alkaline phosphatase Increased ALT/AST Jaundice Leukopenia Pallor Seizures Stevens-Johnson syndrome Taste perversion Thrombocytopenia Toxic epidermal necrolysis Hypersensitivity to other azoles Use caution in proarrhythmic conditions and renal impairment Use extreme caution or avoid in congenital long-QT patients and patients with conditions that increase QT-prolongation risk Fluconazole inhibits CYP2C9, CYP2C19, and CYP3A4 isoenzymes; coadministration with drugs that are substrates if these isoenzymes may be contraindicated or warrant dosage modifications Capsules contain lactose and should not be given to patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption Powder for oral suspension contains sucrose and should not be used in patients with hereditary fructose, glucose/galactose malabsorption or sucrase-isomaltase deficiency Syrup contains glycerol; may cause headache, stomach upset, and diarrhea Hepatotoxicity reported with use; use with caution in patients with hepatic impairment Rare exfoliative skin disorders reported; monitor closely if rash develops and discontinue if it progresses When driving vehicles or operating machines, it should be taken into account that dizziness or seizures may occasionally occur Candida krusei is inherently resistant Convenience and efficacy of single dose oral tablet of fluconazole regimen for the treatment of vaginal yeast infections should be weighed against acceptability of higher incidence of drug related adverse events with fluconazole (26%) versus intravaginal agents (16%) If drug is used during pregnancy or if patient becomes pregnant while taking the drug, patient should be informed of potential hazard to fetus; effective contraceptive measures should be considered in women of child-bearing potential who are being treated with 400 to 800 mg/day and should continue throughout the treatment period and for approximately 1 week (5 to 6 half-lives) after the final dose Highly selective inhibitor of fungal cytochrome P-450-dependent enzyme lanosterol 14-alpha-demethylase Subsequent loss of normal sterols correlates with accumulation of 14 alpha-methyl sterols in fungi and may be responsible for the fungistatic activity of fluconazole Additive: TMP-SMX Y-site: Amphotericin B, amphotericin B cholesteryl sulfate, ampicillin, calcium gluconate, cefotaxime, ceftazidime(? ), ceftriaxone, cefuroxime, chloramphenicol, clindamycin, co-trimoxazole, diazepam, digoxin, erythromycin lactobionate, furosemide, haloperidol, hydroxyzine, imipenem/cilastatin, pentamidine, piperacillin, ticarcillin, TMP-SMX Solution: D5W, LR Additive: Acyclovir, amikacin, amphotericin B, cefazolin, ceftazidime, ciprofloxacin, clindamycin, gentamicin, heparin, meropenem, metronidazole, morphine, piperacillin, potassium chloride, ranitidine with ondansetron, theophylline Y-site: Acyclovir, aldesleukin, allopurinol, amifostine, amikacin, aminophylline, amiodarone, ampicillin-sulbactam, aztreonam, benztropine, bivalirudin, cefazolin, cefepime, cefotetan, cefoxitin, cefpirome, chlorpromazine, cimetidine, cisatracurium, dexamethasone sodium phosphate, dexmedetomidine, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin liposomal, droperidol, etoposide PO4, famotidine, fenoldopam, filgrastim, fludarabine, foscarnet, ganciclovir, gatifloxacin, gemcitabine, gentamicin, granisetron, heparin, hetastarch, hydrocortisone, immune globulin, leucovorin, linezolid, lorazepam, melphalan, meperidine, meropenem, metoclopramide, metronidazole, midazolam, morphine, nafcillin, nitroglycerin, ondansetron, oxacillin, paclitaxel, pancuronium, penicillin G, phenytoin, piperacillin-tazobactam, prochlorperazine, promethazine, propofol, quinupristin-dalfopristin, ranitidine, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin-clavulanate, tobramycin, vancomycin, vecuronium, vinorelbine, zidovudine Tablets: Store below 86° F (30° C) Dry powder: Store below 86° F (30° C); reconstituted suspension should be stored between 86° F (30° C) and 41° F (5° C), and unused portion should be discarded after 2 weeks; protect from freezing Injection (glass bottles): Store between 86° F (30° C) and 41° F (5° C); protect from freezing Injection (Viaflex Plus plastic containers): Store between 77° F (25° C) and 41° F (5° C); protect from freezing The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

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    Medscape - Candidia infection dosing for Diflucan fluconazole, frequency-based. Recommended duration of therapy is 10-12 weeks after cerebrospinal fluid. Fluconazole learn about side effects, dosage, special precautions, and more on MedlinePlus Fluconazole is an antifungal azole, and its use, indication, potential contraindications, and adverse events and drug interactions are discussed in this article.

    uses cookies to improve performance by remembering your session ID when you navigate from page to page. Please set your browser to accept cookies to continue. This cookie stores just a session ID; no other information is captured. Accepting the NEJM cookie is necessary to use the website. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. Six months of weekly maintenance followed, with 150 mg fluconazole or placebo. Paul Nyirjesy, MDProfessor, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia Immediately before randomization, all patients had a culture-proven episode of candidiasis, which was successfully treated with 3 doses of fluconazole (150 mg each) given orally at 72-hour intervals. At the end of 6 months, 13/141 (9%) of the fluconazole group and 91/142 (64%) of the placebo group had suffered recurrent candidiasis (PFor the gynecologist, recurrent candidiasis is one of those niggling, but pervasive, challenges of practice. But for the woman subject to repeated outbreaks, it is a major obstacle to quality of life, even though episodic antifungal treatment is readily available with or without a visit to the office. As physicians, we just don’t appreciate the negative impact that recurrent candidiasis has on a woman’s daily functioning. Although prolonged (6-month) antifungal therapy has proven effective against recurrent candidiasis, some women object to the extended use of topical antifungals, and oral therapy with ketoconazole is associated with hepatotoxicity. This study showed that weekly oral fluconazole for 6 months is an effective and acceptably safe way to suppress recurrences.

    Fluconazole therapy

    Fluconazole - an overview ScienceDirect Topics, Fluconazole MedlinePlus Drug Information

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  7. N Engl J Med. 2004 Aug 26;3519876-83. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. Sobel JD1, Wiesenfeld HC, Martens M.

    • Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis..
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    Learn about Diflucan Fluconazole may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications. When fluconazole therapy is initiated with a single loading dose equal to twice the usual daily dosage and followed by the usual dosage given once daily thereafter. Eur J Obstet Gynecol Reprod Biol. 2013 Apr;1672132-6. doi 10.1016/j.ejogrb.20. Epub 2012 Dec 29.

     
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