Pregnancy Category C
Drug classes of Fluconazole
Therapeutic actions of Fluconazole
Fluconazole is a highly selective inhibitor of fungal cytochrome
P-450 sterol C-14
alpha-demethylation. This decreases ergosterol synthesis which is the principal sterol in fungal cell membranes, thus inhibiting cell membrane formation.
Indications of Fluconazole
- Vaginal candidiasis (vaginal yeast infections due to Candida).
- Oropharyngeal and esophageal
candidiasis. In open noncomparative studies of relatively
small numbers of patients, fluconazole was also effective for the treatment of Candida
urinary tract infections, peritonitis, and systemic Candida infections including candidemia,
disseminated candidiasis, and pneumonia.
- Cryptococcal meningitis.
- Prophylaxis. fluconazole is also indicated to decrease the incidence of candidiasis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy and/or radiation therapy.
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 the results of the cultures and other laboratory studies are known; however, once these results become available, anti-infective therapy should be adjusted accordingly.
Contraindications/cautions of Fluconazole
- hypersensitivity to fluconazole or to any of its excipients. Caution should be used in prescribing fluconazole to patients with hypersensitivity to other azoles.
- Concomitant adminstration with terfanidine, cisapride or astemizole.
- Patients with liver failure.
- Fluconazole should be administered with caution to patients with these potentially proarrhythmic conditions.
Adverse effects of Fluconazole
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toxicity, including fatalities primarily in patients with serious underlying medical
conditions. Fluconazole hepatotoxicity has usually, but not always, been reversible on discontinuation of therapy.
malignancy), these have rarely resulted in a fatal outcome. Patients who develop rashes during treatment with fluconazole should be monitored closely and the drug discontinued if lesions progress.
involved seriously ill patients with multiple confounding risk factors, such as structural heart disease, electrolyte abnormalities and concomitant medications that may have been contributory. Fluconazole should be administered with caution to patients with these potentially proarrhythmic conditions.
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