fluconazole (Diflucan)

Drug description
Fluconazole is used for treating fungal infections such as Candida albicans and Cryptococcal meningitis. Candida infection can show up as thrush in the mouth, or vaginal candidiasis. Cryptococcal meningitis is inflammation of the linings of the brain or spinal cord. Most people who develop cryptococcal meningitis have T4 cell counts below 100. Another fungal infection, coccidioidomycosis, can also be treated with fluconazole. Some doctors are starting people with low T4 cell counts on fluconazole or a related drug, itraconazole, as preventive treatment for fungal infections. Pfizer Inc., who makes Diflucan, has a Patient Assistance Program that can be reached at 800.869.9979.

Side effects
Fluconazole has fewer side effects than the previous standard treatment, amphotericin B (Fungizone). Side effects can include headache, nausea, vomiting, abdominal discomfort, and diarrhea. Although elevation in liver function tests is possible, this drug has far less liver toxicity than ketoconazole. Liver dysfunction can show up as unusual fatigue, anorexia, nausea, vomiting, jaundice, dark urine, or pale stools. There have also recently been reports of reversible hair loss after long term use of fluconazole.

Dosage
Fluconazole is available in pill form. Fluconazole can be safely taken with AZT. Dosage is dependent on infection and can be pill or intravenous form. Dosage for esophageal candidiasis is 200 mg initially, then 100 mg once daily for at least 3 weeks or 2 weeks following symptomatic improvement. Up to 400 mg/day has been used.

How long it may take to work
Fluconazole should be used on an ongoing basis after one episode of cryptococcus. There is not much data on using fluconazole for prevention. Maintenance with fluconazole is common if there are recurrences of thrush. Maintenance treatment means you keep taking the drug to control an infection so that you don't become ill. For candida infection, treatment usually lasts 3-4 weeks. For cryptococcal meningitis, treatment lasts 10-12 weeks, followed by suppressive therapy of 200 mg once daily. Full course of therapy may require weeks or months of treatment following resolution of symptoms.

Managing side effects
If any of symptoms of liver dysfunction occur, notify your doctor immediately.

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