The structural formula is:. After reconstitution with 24 mL of distilled water or Purified Water USPeach mL of reconstituted suspension contains 10 mg or 40 mg of fluconazole.
Specimens for fungal culture and other relevant laboratory studies serology, histopathology should be obtained prior to therapy to isolate and identify causative organisms. Therapy may be instituted before diflucan and propulsid heart problems results of the cultures diflucan and propulsid heart problems other laboratory studies are known; however, once these results become diflucan and propulsid heart problems, anti-infective therapy should be adjusted accordingly.
In general, a loading dose of twice the daily dose is recommended on the first day of therapy to result in plasma concentrations close to steady-state by the second day of therapy. Treatment should be continued until clinical parameters or laboratory tests indicate that active fungal infection has subsided.
An inadequate period of treatment may lead to recurrence of active infection. Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse. Clinical evidence of oropharyngeal candidiasis generally resolves within several days, but treatment should be continued for at least 2 weeks to decrease the likelihood of relapse. Patients with esophageal candidiasis should be treated for a minimum of three weeks and for at least two weeks following resolution of symptoms.
For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established. In open, noncomparative studies of small numbers of patients, doses coreg and renal dysfunction up to mg daily have been used, diflucan and propulsid heart problems.
For the treatment of Candida urinary tract infections and peritonitis, daily doses of mg have been used in open, noncomparative studies of small numbers of patients. The recommended dosage for treatment of acute cryptococcal meningitis is mg on the first day, followed by mg once daily. The recommended duration of treatment for initial therapy of cryptococcal meningitis is weeks after the cerebrospinal fluid becomes culture negative, diflucan and propulsid heart problems.
Patients who are anticipated to have severe granulocytopenia less than neutrophils per cu mm should start DIFLUCAN prophylaxis several days before the anticipated onset of neutropeniaand continue for 7 days after the neutrophil count rises above cells per cu mm. The following dose equivalency scheme should generally provide equivalent exposure in pediatric and adult patients:, diflucan and propulsid heart problems. After the first two weeks, these children should be dosed once daily.
Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse. Patients with esophageal candidiasis should be treated for a minimum of three weeks and for at least 2 diflucan and propulsid heart problems following the resolution of symptoms.
Fluconazole is cleared primarily by renal excretion as unchanged drug. There is no need to adjust single dose therapy for vaginal candidiasis because of impaired renal function. After the loading dose, the daily dose according to indication should be based on the following table:.
These are suggested dose adjustments based on pharmacokinetics following administration of multiple doses. Further adjustment may be needed depending upon clinical condition. When serum creatinine is the only measure of renal function available, the following formula based on sex, weight, and age of the patient should be diflucan and propulsid heart problems to estimate the creatinine clearance in adults:.
Although the pharmacokinetics diflucan and propulsid heart problems fluconazole has not been studied in diflucan and propulsid heart problems with renal insufficiency, dosage reduction in children with renal insufficiency should parallel that recommended for adults. The following formula may be used to estimate creatinine clearance in children:. Prepare a suspension at time of dispensing as diflucan and propulsid heart problems To reconstitute, add 24 mL of distilled water or Purified Water USP to fluconazole bottle and shake vigorously to suspend powder.
Each bottle will deliver 35 mL of suspension. The concentrations of the reconstituted suspensions are as follows:, diflucan and propulsid heart problems. Shake oral suspension well before using.
Pink trapezoidal tablets containing 50,or mg of fluconazole are packaged in bottles or unit dose blisters. The mg fluconazole tablets are pink and oval shaped, packaged in a single dose unit blister. Bottles of 30 NDC Unit dose package of Fluconazole mg per bottle NDC Fluconazole mg per bottle. In some patients, particularly those with serious underlying diseases such as AIDS and cancer, changes in renal and hematological function test results and hepatic abnormalities have been observed during treatment with fluconazole and comparative agents, but the clinical significance and relationship to treatment is uncertain.
Most of the reported side effects were mild to moderate in severity. Rarely, angioedema and anaphylactic reaction have been reported in marketing experience. Treatment was discontinued in 1. The proportions of patients discontinuing therapy due to clinical adverse events were similar in the two groups 1. The spectrum of these hepatic reactions has ranged from mild transient elevations in transaminases to clinical hepatitischolestasis and fulminant hepatic failure, including fatalities.
Instances of fatal hepatic reactions were noted to occur primarily in patients with serious underlying medical conditions predominantly AIDS or malignancy and often while taking multiple concomitant medications. Transient hepatic reactions, including hepatitis and jaundicehave occurred among patients with no other identifiable risk factors.
These elevations occurred in patients with severe underlying disease, predominantly AIDS or malignancies, most of whom were receiving multiple concomitant medications, including many known to be hepatotoxic. The incidence of abnormally elevated serum transaminases was greater in patients taking DIFLUCAN concomitantly with one or more of the following medications: In rare cases, anaphylaxis including angioedema, face edema and pruritus has been reported.
Body as a Whole: Astheniafatigue, fever, malaise. QT prolongation, torsade de pointes. Leukopeniaincluding neutropenia and agranulocytosisthrombocytopenia.
Hypercholesterolemiahypertriglyceridemia, hypokalemia. Cholestasis, dry mouthhepatocellular damage, dyspepsia, vomiting.
Insomnia, paresthesiasomnolencetremorvertigo. Acute generalized exanthematous- pustulosisdrug eruption, increased sweating, exfoliative diflucan and propulsid heart problems disorders including Stevens-Johnson syndrome and toxic epidermal necrolysis see WARNINGSalopecia. The pattern and incidence of adverse events and laboratory abnormalities diflucan and propulsid heart problems during pediatric clinical trials are comparable to those seen in adults.
Thirteen percent of children experienced treatment-related adverse events. Treatment was discontinued in 2. The majority of treatment-related laboratory abnormalities were elevations of transaminases or alkaline phosphatase. Estradiol and transgender, caution should be exercised when using these combinations and the patients should be carefully monitored.
The enzyme inhibiting effect of fluconazole persists days after discontinuation of fluconazole treatment due to the long half-life of fluconazole.
These are described in greater detail below:. When DIFLUCAN is used concomitantly with these or other sulfonylurea oral hypoglycemic agents, blood glucose concentrations should be carefully monitored and the dose of the sulfonylurea should be adjusted as necessary.
In post-marketing experience, diflucan and propulsid heart problems, as with other azole antifungals, bleeding events bruising, epistaxisgastrointestinal bleeding, hematuriaand melena have been reported in association with increases in prothrombin time in patients receiving fluconazole concurrently with warfarin. Dose adjustment of warfarin may be necessary. This combination may be used by reducing the dosage of cyclosporine depending on cyclosporine concentration.
Because of the occurrence of serious cardiac dysrhythmias secondary to prolongation of the QTc interval in patients receiving azole antifungals in conjunction with terfenadine, interaction studies have been performed.
One study at a mg daily dose of fluconazole failed to demonstrate a prolongation in QTc interval. Another study at a mg and mg daily dose of fluconazole demonstrated that DIFLUCAN taken in doses of mg per day or greater significantly increases plasma levels of terfenadine when taken concomitantly, diflucan and propulsid heart problems. The combined use of fluconazole at doses of mg or greater with terfenadine is contraindicated. There have been reports of cardiac events, including torsade de pointes, in patients to whom fluconazole and cisapride erectile dysfunction and bacterial infection coadministered.
A controlled study found that concomitant fluconazole mg once daily and cisapride 20 mg four times a day yielded a significant increase in cisapride plasma levels and prolongation of QTc interval.
The combined use of fluconazole with cisapride is contraindicated. Concomitant administration of fluconazole with astemizole may decrease the clearance of astemizole.
Resulting increased plasma concentrations of astemizole can lead to QT prolongation and rare occurrences of torsade de pointes.
Coadministration of fluconazole and astemizole is contraindicated. There have been reports of uveitis in patients to whom fluconazole and rifabutin were coadministered. Patients receiving rifabutin and fluconazole concomitantly should be carefully monitored. Avoid concomitant administration of voriconazole and fluconazole. Monitoring for adverse events and toxicity related to voriconazole is recommended; especially, if voriconazole is started within 24 h after the last dose of fluconazole.
Fluconazole may increase the serum concentrations of orally administered tacrolimus up to 5 times due to inhibition of tacrolimus metabolism through CYP3A4 in the intestines. No significant pharmacokinetic changes have been observed when tacrolimus is given intravenously. Increased tacrolimus levels have been associated with nephrotoxicity. Dosage of orally administered tacrolimus diflucan and propulsid heart problems be decreased depending on tacrolimus concentration.
Following oral administration of midazolam, fluconazole resulted in substantial increases in midazolam concentrations and psychomotor effects. This effect on midazolam appears to be more pronounced following oral administration of fluconazole than with fluconazole administered intravenously. If short-acting benzodiazepines, which are metabolized by the cytochrome P system, diflucan and propulsid heart problems, are concomitantly administered with fluconazole, consideration should be given to decreasing the benzodiazepine dosage, and the patients should be appropriately monitored.
Systemic exposure to tofacitinib is increased when tofacitinib is coadministered with fluconazole, a combined moderate CYP3A4 and potent CYP2C19 inhibitor. Reduce the dose of tofacitinib when given concomitantly with fluconazole i. Dosage adjustments of triazolam may be necessary.
Two pharmacokinetic studies with a combined oral contraceptive have been performed using multiple doses of fluconazole. Thus, multiple dose use of fluconazole at these doses is unlikely to have an effect on the efficacy of the combined oral contraceptive. Although not studied in vitro or in vivo, concomitant administration of fluconazole with pimozide may result in inhibition of pimozide metabolism.
Increased pimozide plasma concentrations can lead to QT prolongation and rare occurrences of torsade de pointes. Coadministration of fluconazole and pimozide is contraindicated. Although not studied in vitro or in vivo, concomitant administration of fluconazole with quinidine may result in inhibition of quinidine metabolism.