Diflucan 150mg Pfizer treats fungal infection (1 blister x 1 tablet)

Dosage form Box of 1 blister x 1 tablet
Specifications Fluconazole
Ingredient Pfizer

Ingredient

Composition information	Content
Fluconazole	150mg

Uses

Indications

diflucan is indicated for the following fungal infections:

diflucan is assigned to use in adults for treatment

Cryptococcus meningitis.

Coccidioides infection.

Invasive Candida infection.

Mucus infections include oral - pharynx contamination, esophagus, ureter and Candida infection in the skin - chronic mucosa.

Candida infection causes atrophy in chronic mouth (dental pain) if dental hygiene or local treatment does not respond sufficiently.

Vaginal, acute or chronic candidiasis; When inappropriate local treatment.

Candida foreskin when local therapy is inappropriate.

Fungal fungal infections include fungus, stem, inguinal mushrooms, tinea versicolor and candidiasis infections in the skin when prescribed systemic therapy.

Mushrooms when other drugs are considered inappropriate.

diflucan is used in adults for backup

Relapse of Cryptococcus meningitis in patients with high risk of recurrence.

Oral Candida - Mate or Esalmagds infection in HIV -infected patients is at high risk of recurrence.

To reduce the rate of chronic negative candidiasis (from 4 times or more a year).

Preventive contamination of Candida infection in patients with prolonged neutropenia (such as patients with malignant blood tumors are being valid or patients with stem cell transplantation).

diflucan is assigned for newborns, newborns, new children, children, and teenagers aged 0 to 17 years old

Diflucan is used to treat mucosal candidiasis (mouth - pharynx, esophagus), invasive candidiasis infection, cryptococcus meningitis and contaminating candidiasis in immunodeficiency patients. Diflucan can be used to treat the recurrence of Cryptococcus meningitis in children with high risk of recurrence.

can be conducted before knowing the results of culture and other test results; However, when there are results, should adjust the anti -bacterial treatment accordingly.

Should refer to the official instructions on how to use proper antifungal drugs.

Pharmacokic of

both oral and intravenous sugars of fluconazole gives effects on many animal infection models. The effect has been proven to combat opportunistic fungal infections, such as Candida spp infection, including systemic candidiasis infection in immunodeficiency animals; Cryptococcus NEOFOFERMans infection, including fungal infection in the skull, microsporum spp infection, and Trichophyton spp infection.

Fluconazole has also been shown to work on the model of animal infections of local epidemiological fungus, including blastomyces dermatitidis, and Coccidioides immitis, including fungal infections in the skull and Histoplasma capsulatum infection in normal immunosuppression animals and immunodeficiency animals.

There have been reports on the case of superinfection against non -C. albicans, which are often not sensitive to fluconazol (for example, Candida Krusei). Such cases often need replacement treatment with other antifungal drugs.

fluconazole has a high selective effect with enzymes depending on the mushroom cytochrom P450. Fluconazole 50mg daily used for up to 28 days has been shown to not affect the concentration of testosterone in plasma in men and steroid concentration in women in childbearing age.

Fluconazole 200 - 400mg daily does not have a significant impact on clinical tickets on endogenous steroids or on the response stimulated by ACTH on healthy male volunteers. Studies on interactive with antipipin show that the use of single -dose or multiple doses of fluconazole 50mg does not affect the metabolism of this substance.

pharmacokinetic pharmacokinetics

Fluconazol pharmacokinetic properties are the same after using intravenous or oral routes. After taking Fluconazole well, the plasma (and systemic) concentration is over 90% of the concentration achieved after using intravenous lines. Oral absorption is not affected by use with food.

Plasma concentrations in hunger appears between 0.5 to 1.5 hours after drinking with a half -life of plasma waste approximately 30 hours. Plasma concentrations are proportional to the dose. 90% of the concentration in the state of plasma is achieved on Wednesday or Thursday in the regimen of multi -dosely used doses.

Using the attack dose (on 1 day 1) twice as normal daily dose makes the plasma concentration reach approximately 90% of the concentration in the status of the 2nd day. The ability to attach to plasma proteins is low (11 - 12%).

Fluconazole has the ability to absorb well into all the fluid's fluids that have been studied. Fluconazole's concentration in saliva and sputum is equivalent to its concentration in plasma, in patients with fungal meningitis, the concentration of fluconazole in the brain reaches approximately 80% of its corresponding concentration in plasma.

The concentration of fluconazole on the skin is high, higher than its concentration in plasma, achieved in the horny layer, epidermis - feet and sweat. Fluconazole is accumulated in the skin's horny layer. At a dose of 50mg once daily, the concentration of fluconazole after 12 days is 73mg/g and 7 days after stopping the concentration of fluconazole is still 5.8mg/g.

With a dose of 150mg used in a one -sided row, the concentration of fluconazole in the horn layer on Saturday is 23.4mg/g and 7 days after using the second dose of concentration in the horn layer is still 7.1mg/g.

The concentration of fluconazole at the foundation after four months of use at a dose of 150mg used in a row tuan is 4.05mg/g at a healthy nail and 1.8mg/g in the disease; And Fluconazole can still be found in 6 months of nail pattern after the end of treatment.

The main elimination of fluconazole is the kidney, with a stack of 80% of the doses of use appears in the form of unchanged urine. The clearance of fluconazole is proportional to the clearance of creatinine. There is no evidence that there are its metabolites during circulation.

Semi -prolonged semi -discharged time is the basis for the single -dose treatment regimen for vaginal candidiasis, used once daily and once weekly for other indications.

A study compares the concentration in saliva and plasma of the single dose of Fluconazole 100mg used in the form of capsules or oral fluid, used by rinse and hold in the mouth for 2 minutes then swallow.

The maximum concentration of fluconazole in saliva after using the kiss form appears 5 minutes after a waste and 182 times higher than the maximum concentration in the saliva after using the capsule, appearing 4 hours after drinking. After approximately 4 hours, the concentration of fluconazol's saliva is similar. The area under the average curve AUC (0.%) in saliva is significantly higher after using the mixed form compared to when using the capsule form.

There is no significant difference in the rate of elimination from saliva or pharmacokinetics parameters in plasma to both formulas.

Pharmacokinetics in the elderly

Conduct pharmacokinetic research on 22 people, age> = 65, take a single dose of 50mg fluconazole. Of these, 10 patients take more diuretic. CMAX is 1.54MCG/ml and achieved after 1.3 hours. The average AUC is 76.4 ± 20.3mcg/hour/ml and the average selling time is 46.2 hours. These values of pharmacokinetics are higher than the values of the measured parameters on healthy male volunteers.

Coordinate with diuretic drugs does not have a clear effect on AUC or CMAX, of fluconazole. Moreover, creatinine clearance (74ml/minute), percentage of the drug (has not metabolized) found in the urine (0 - 24 hours, 22%) and the purification of fluconazol through the kidney (0.124ml/min/kg) in the elderly is usually lower than these parameters in young volunteers. Therefore, the pharmacokinetic change of fluconazole in the elderly may be due to impaired renal function at this age.

The last selling time of the sale time - the clearance of creatinine in each individual comparable to the end of the semi -waste time - the clearance of creatinine in normal people and those with different levels of renal failure shows us falling into 21 of the 22 patients, with 95% of the reliable limit of the ultimate sale of the exhaust time - the clearance of Creatinin.

These results are consistent with the theory that the values are higher than the dynamic parameters in the elderly compared to the healthy mushroom volunteers due to impaired renal function in old age.

Clinical safety data

Cancer ability:

fluconazole does not show evidence of the likelihood of cancer in mice and white mice treated by oral route for 24 months with 2.5 doses; 5 or 10mg/kg/day (approximately 2-7 times the recommended dose of the person). The male mouse is treated at a dose of 5 - 10mg/kg/day with an increase in the cases of liver cell gland tumors.

The ability to cause mutations:

fluconazole, whether or not to activate metabolic, negative results in tests of mutant possibility in four Salmonella Typhimurium strains and in the lymphatic tumor system in L5178Y mouse. Studies on cell genetics, on Vivo (mouse bone marrow cell after taking fluconazol) and on in vitro (in the lymph cells of the person who is in contact with fluconazole at a dose of 1000mg/ml) does not show evidence of chromosomal mutations.

Perfect fertility:

Fluconazole does not affect fertility in male mice or female mice treated with oral daily dose 5.10 or 20mg/ICP or with willow injection 5.25 or 75mg/kg, although labor lasts a bit at a dose of 20mg/kg oral.

In a study using intravenous lines during mice at 5.20 and 40mg/kg doses, giving birth difficult and prolonging labor time observed at some mothers at a dose of 20mg/kg (approximately 5-15 times the recommended dose in humans) and 40mg/kg, but does not appear this effect at 5mg/kg dose. Disorders during childbirth are reflected by the slight increase in the amount of fetal loss and reduce the rate of newborn survival with these doses.

The effect of rat births is due to the specific properties of the species -caused species caused by high doses of fluconazole. Such hormone changes are not observed in women using fluconazole.

Before taking Diflucan 150mg Pfizer treats fungal infection (1 blister x 1 tablet)

How to use

Take the tablet with a full glass of water.

Dosage

Fluconazole's daily dose should be based on the nature and degree of fungal infection. Most of the cases of vaginal candidiasis respond to a single dose treatment regimen.

For cases of fungal infections that need to use multi -dose treatment regimen, Can continue treatment until clinical parameters or tests show that the active fungal infection has been improved.

Introdable treatment can lead to relapse of active fungal infections. Patients with AIDS and meningitis caused by cryptococcus or oral candidiasis - recurrent pharynx often need to be maintained to prevent recurrence.

Adults

To prevent the re -infection of the mouth - servant in AIDS patients after the patient has been treated a full batch under the basic treatment, can use Fluconazol at a dose of 150mg once a week.

Treatment of vaginal candidiasis, using Fluconazole 150mg a single dose.

To reduce the rate of recurrent vaginal candidiasis, fluconazole can be used 150mg once a month. The treatment time depends on each fish but is in the range of 4 - 12 months, some patients may need to use the dose more often.

Dual diflucan dosage 150mg treatment for foreskin caused by Candida, using Fluconazole 150mg oral 1 doses only.

Fluconazole's recommended dose to prevent Candida Fungal infection is from 150 - 300mg to use daily, depending on the risk of patient mushroom development. It is necessary to start using fluconazole a few days before appearing neutropenia as predicted and maintained 7 days after the number of neutrophils increased to 1,000 cells per mm3.

Dift doses of 150mg treatment of skin fungal fungal infections include foot fungus, stem fungus, inguinal mushrooms and skin infections, recommended doses of 150mg once a week. The normal treatment time is from 2 to 4 weeks but the leg mushroom may need treatment up to 6 weeks.

Diflucan dosage 150mg treatment of tinea versicolor, recommended dose is 300mg once per week for 2 weeks; The 300mg dose may be taken for the third week in some patients, whereas in some other patients with a single dose of 300 to 400mg may be sufficient.

Diflucan dosage 150mg of foundation mushrooms, recommended dose is 150mg once per week, it is necessary to continue treatment until the nail infection is replaced (the new foundation has not been developed instead). The re -development of nails and toenails usually need to be corresponding from 3 to 6 months and from 6 to 12 months. However, the growth rate may vary greatly depending on the individual and age. For chronic fungal infections for a long time, after successful treatment, the foundation is sometimes deformed.

Used in elderly patients

In patients with no evidence of renal failure, it is recommended to follow the usual dose. In patients with renal failure (creatinine clearance

Patients with renal failure

fluconazole is excreted mainly through urine in the form of unchanged. There is no need to adjust the dose in the only dose treatment regimen, in patients (including children) with impaired renal function, but it is necessary to use the Fluconazol multi -dose regimen, the starting dose is 150mg - 300mg. Then the daily dose (depending on indications) should be based on the following information:

Creatinine clearance (ml/min)> 50: No dose adjustment.

Regular hemorrhage: No need to adjust the dose after each hemorrhage. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

In case of overdose, symptomatic treatment (by resuscitation and gastric lavage if necessary) may be sufficient.

Diflucan 150mg is excreted in urine, so mandatory diuretic can increase the speed of fluconazol's elimination. The dialysis of dialysis in 3 hours reduces the plasma fluconazole levels about 50%.

What to do when forgetting a dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

Diflucan 150mg is generally good tolerated. In some patients, especially for patients with diseases such as AIDS and cancer, changes in the results of hematology and kidney function and the abnormalities of the liver) are observed when treated with fluconazol and comparative drugs, but clinical significance and relationship with uncertain therapy.

Unwanted effects have been observed and reported during Fluconazol's treatment at the following frequency:

common side effects (> 1/100 -

Nervous disorders: headache.

Gastrointestinal disorders: abdominal pain, diarrhea, nausea, vomiting.

Alanin amino hydrolysis enzyme hyperplasia, increased amino hydrolysis enzymes of Aspartat, increased hematuria phosphatas.

Skin and subcutaneous disorders: rash.

Side effects are less common (> 1/1,000 -

Mental disorders: Insomnia, Sleeping.

Nervous system disorders: convulsions, dizziness, paresthesia, change taste.

Disorders of hearing and internal ears: dizziness.

Gastrointestinal disorders: indigestion, flatulence, dry mouth.

Liver disorders: cholestasis, jaundice, increase bilirubin.

Skin and subcutaneous tissue disorders: itching, urticaria, increased sweating, drug rash.

Muscle and connective muscle disorders: muscle pain.

Systemic disorders and condition at the place of use: fatigue, difficulty living, weakness, fever.

Rare side effects (> 1/10,000 -

Blood disorders and lymphatic systems: granulocytosis, leukopenia, neutropenia, thrombocytopenia.

immune system disorders: Anaphylaxis, angioedema.

Metabolic and nutrition disorders: hypereminemia, hypercholesterolemia, hypokary blood.

Nervous disorders: Run.

Cardiovascular disorders: Twisted phenomenon, extending the QT range.

Liver disorders: toxicity to the liver, including rare cases of death, liver failure, liver necrosis, hepatitis, liver cell damage.

Skin and subcutaneous disorders: Poisoned epidermal necrosis, Stevens - Johnson syndrome, acute bodyburges, peeling dermatitis, face edema, hair loss.

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using Diflucan 150mg, you need to read the instructions carefully and refer to the information below.

Contraindicated

Diflucan 150mg contraindicated drug in the following cases:

Patients with a history of hypersensitivity to the drug or one of the drug ingredients or for compounds related to the azol group.

Based on the results of an interactive study when using multi -doses, contraindicated use simultaneously terfenadin in patients who are using fluconazole on a 400mg multi -dose regimen daily or higher.

Contrain to use the drugs that extend the QT interval and are metabolized by CYP3A4 enzymes such as Cisaprid, Astemizol, Erythromycin, Pimozide and Quinidin with patients using fluconazole.

Precautions when using

should be cautious when indicating Diflucan 150mg in patients with liver dysfunction.

Diflucan 150mg has been related to a few cases of serious liver toxicity including death, mainly in patients with severe pathology. However, in cases of liver toxicity related to Diflucan 150mg, there is no clear observation of the relationship for the total daily dose, treatment time, gender or age of the patient. Diflucan 150mg toxicity is usually recovered after stopping treatment. Patients with abnormal liver function tests during treatment with Diflucan 150mg should be closely monitored to prevent serious liver damage. Need to stop diflucan 150mg if there are signs and clinical symptoms, there is a growing liver disease that may be due to diflucan 150mg.

has appeared (rare) flaky skin reactions, such as Stevens - Johnson syndrome and poisoned epidermal necrosis in patients during treatment with Diflucan 150mg. AIDS patients are susceptible to severe skin reactions for many drugs. If the skin rash appears to be due to Diflucan 150mg in patients treated with surface fungal infections, it is necessary to stop treating with this drug. If the skin rash appears in patients with systemic fungal infections or invasive fungal infections, closely monitor and stop diflucan 150mg in the event of a diverse water or erythema lesions.

Need to monitor carefully when using simultaneously diflucan 150mg lower doses than 400mg daily with terfenadin.

Like other azols, there have been reports on anaphylaxis but rare.

Some azol, including fluconazol, causes a long -lasting qt on the electrocardiogram. The report after circulation shows that there are very rare cases of the QT and Torsade De Pointes (Torsade de Pointes) on patients using Diflucan 150mg. These reports include patients who are too sick that there are many confusing risk factors, such as structural heart failure, electrolyte abnormalities and coordinated with other drugs that can cause confusion about harmful effects.

Therefore, be careful when using Diflucan 150mg for patients with the risk of arrhythmia as above.

Need to use carefully Diflucan 150mg for patients with renal dysfunction.

fluconazole is a strong inhibitor CYP2C9 and CYP2C19 and medium inhibitor CYP3A4. It is necessary to control when using Diflucan 150mg for patients treated simultaneously with drugs with narrow treatment intervals that are metabolized through CYP2C9, CYP2C19 and CYP3A4.

Diflucan capsules contain lactose are not indicated for patients with genetic problems in galactose tolerance, lactase deficiency or malposure - galactose.

The ability to drive and operate machinery

Be careful when using Diflucan 150mg when driving or operating machines because it can occur dizzy or convulsions.

Pregnancy and lactation

Pregnancy

Data from several hundred pregnant women treated Fluconazol doses

There have been reports on congenital multiple malformations in newborns that their mothers have been treated for more than 3 months with high doses (400 - 800mg/day) of fluconazole for coccidioides infection. The relationship between the use of fluconazol and these cases is unclear, the adverse effects on the embryo are mandarin on animals with very high doses, accompanied by toxic to the mother animal.

There is no impact on the embryo at a dose of 5 or 10mg/kg; Increases the ratio of anatomy of embryo surgery (excess ribs, pelvic expansion and slowing bone process is observed at doses of 25 and 50mg/kg or higher. With doses in the range of 80mg/kg (approximately 20 - 60 times the recommended dose in humans) to 320mg/kg increases the rate of embryo death in white mice and causing embryo deformities including: weak ribs, abnormal surface development.

These effects are due to the inhibition of estrogen synthesis in mice and may be the known effect of lowering estrogen levels to pregnancy, through the process of creating organs and childbirth.

A few reports are published on a special and rare sample of disability at birth on children with mothers using high doses of fluconazole (400 - 800mg) in most or all of the first 3 months of pregnancy. The characteristics when received on children include: short head, abnormal face, abnormal skull development, cleft palate, curved thighs, long bones and thin ribs, curved joint syndrome (Arthrogryposis), congenital heart disease.

Therefore, it is necessary to avoid using Diflucan 150mg in pregnant women except for cases of severe fungal infections or life -threatening, in these patients, they can use Diflucan 150mg if the benefits are on the embryo.

Breastfeeding period

Diflucan 150mg is found in breast milk with the same concentration as plasma, so it is not recommended to use on nursing mothers.

Drug interaction

Contraindicated Diflucan 150mg with the following drugs:

cisaprid

There have been reports on cardiovascular phenomena including Torsade de Pointes) in patients with simultaneous use of Cisaprid and Diflucan 150mg. Controlled research shows that Cisaprid concentration in plasma increases significantly and extends the QT period when indicated simultaneously Fluconazole 200mg at a time and Cisaprid 20mg x4 times/day.

Contrain to use Cisaprid for patients being treated with Diflucan 150mg.

terfenadin

Terfenadin interaction studies have been conducted due to the appearance of serious arrhythmias after the phenomenon of extension of QT in patients treated with antifungal drugs in combination with terfenadin. Research with the dosage of Fluconazole 200mg per day does not detect the extension of the QT range.

A different study with the daily dosage of fluconazole is 400mg and 800mg daily showing that fluconazole at 400mg doses daily or more significantly increases the concentration of terfenadine in plasma when indicated simultaneously fluconazole and terfenadine.

Contraindicated use of Fluconazole to 400mg or higher with terfenadin. Carefully control strictly control when indicated in combination of fluconazole at lower doses of more than 400mg daily with terfenadin.

astemizol

Simultaneous indications Diflucan 150mg with astemizol can reduce the clearance of Astemizol, thus mourning the concentration of Astemizol in plasma, which can lead to extending the QT interval and rarely appears twisted.

Contraindicated to simultaneously use fluconazol and astemizol.

pimozid

Although there is no in vitro or in vivo research, simultaneously indicated fluconazole with pimozid may inhibit the transformation of pimozid. Increasing plasma pimozid concentration can extend the QT interval and sometimes the torsion phenomenon appears.

Contraindicated simultaneously fluconazol and pimozid.

quinidine

Although there is no in vitro or in vivo research, simultaneously indicated fluconazole and quinidine can inhibit quinidine metabolism. Using quinidine can extend the QT interval and sometimes the torsion phenomenon appears.

Contraindicated to simultaneously use fluconazol and quinidine.

erythromycin

Simultaneous indications fluconazole and erythromycin are capable of increasing the risk of heart toxicity (extending the QT range, causing the torsion phenomenon) and thus causing sudden death by the heart.

Contraindicated to simultaneously use fluconazol and erythromycin.

simultaneously indicates fluconazole with other drugs below should be cautious and adjust the dose:

The effect of other drugs on fluconazole

hydrochlorothiazid: In a pharmacokinetic interaction study, simultaneously indicated multi -dose hydrochlorothiazide for healthy volunteers using fluconazole to increase the plasma concentration of fluconazole by 40%. This effect requires the need to change the dosage mode of fluconazole in those who are taking diuretics simultaneously with fluconazol.

rifampicin: Simultaneously indicates fluconazole with rifampicin reduces 25% of the area under the curve (AUC) of fluconazol and shortens 20% of fluconazol's exhaust time. In patients with simultaneous use of rifampicin with fluconazole, it is necessary to consider increasing the dose of fluconazol.

The effect of fluconazole on other drugs

Fluconazole is a strong inhibitor of the isenzyme 2C9 and 2C19 of Cytochrom P450 (CYP) and is a medium inhibitor CYP3A4. In addition to the observation interactions and mentioned below, there is a risk of increased concentration of other drugs metabolized by CYP2C9, CYP2C19 and CYP3A4 when indicated simultaneously with fluconazol. Therefore, it is necessary to be cautious when used in combination with the above drugs with fluconazole and patients need to be strictly controlled. The enzyme inhibitory effect of fluconazole lasts 4-5 days after stopping treatment with fluconazole due to fluconazole with long selling time.

Alfentanil: A study showed that the clearance and distribution of Alfentanil's distribution as well as T1/2 of Alfentanil lasted when used in combination with Alfentanil with fluconazole. The impact mechanism may be caused by Fluconazole inhibiting CYP3A4. Alfentanil's dose may be adjusted.

amitriptylin, nortriptylin: fluconazole increases the effects of amitriptylin and nortriptylin. 5 - Nortriptylin and/or S - Amitriptylin can be measured at the time of combined treatment and 1 week later. The dose of amitriptylin/nortriptylin should be adjusted if necessary.

amphotericin B: Concomitance indication of fluconazol and amphotericin B for mice with normal infections and immunosuppressive inhibitors shows the following results: The slightly increased antifungal effect for C.Albicans in systemic infections, no interaction with intracranial infections caused by cryptococcus neoformans, antagonism between fluconazole and amphototicin Aspergillus fumigates. The clinical significance of the results obtained in these studies is not known.

anticoagulants:

In an interactive study, fluconazole increases prothrombin time (12%) after using warfarin on healthy male volunteers. The data after the drug launched to the market showed that, as well as with other antifungal drugs, bleeding problems (bruising, nosebleeds, gastrointestinal bleeding, hematuria and black feces) were reported accompanied by an increase in prothrombin in patients using fluconazol simultaneously with warfarin.

Prothrombin time in patients who are using COMARIN anticoagulants should be carefully monitored. Warfarin's dose may be needed.

azithromycin: Open, random, 3 -dimensional label research on 18 healthy volunteers, evaluate the single dose of 1200mg azithromycin on the pharmacokinetics of the single dose of 800mg fluconazole, while assessing the effect of fluconazol on the pharmacokinetics of azithromycin. The results showed no significant interaction about pharmacokinetics between fluconazol and azithromycin.

Benzodiazepine (short effects): After simultaneous use of Midazolam oral, fluconazole significantly increases Midazolam concentration and affects mental mental mental. This impact on Midazolam proved stronger after using oral fluconazole compared to intravenously.

If it is necessary to treat benzodiazepine simultaneously in patients being treated with fluconazol, it is necessary to consider reducing benzodiazepine dose and patients need to be monitored appropriately.

fluconazole increases the AUC of triazolam (single dose) about 50%, CMAX 20 - 32% and T1/2 25 - 50% due to triazolam metabolism inhibitors. Triazolam's dose may be needed.

carbamazepin: fluconazole inhibits carbamazepine metabolism and increases carbamazepine levels in serum 30%. There is a risk of increasing carbamazepine toxicity. Adjusting the dose of carbamazepin may be necessary depending on the effective measurement rate.

Calcium channel blockers: Some calcium channel blockers (nifedipin, isradipin, amlodipin, verapamil and felodipine) are metabolized by CYP3A4. Fluconazole can increase the concentration of car channel blockers in serum. Recommendations regularly control harmful effects.

Celecoxib: When treating simultaneously Fluconazole (200mg per day) and Celecoxib (200mg), CMAX of Celecoxib increased by 68% and Celecoxib's AUC increased by 134%. A half -dose of Celecoxib may be necessary when used in combination with fluconazole.

cyclosporin: fluconazole significantly increases the concentration and auc of cyclosporin. Cyclosporin can be used with fluconazole by reducing the dose of cyclosporin depending on the concentration of cyclosporin.

cyclophosphamide: Concomitantly indicated cyclophosphamide and fluconazole increases bilirubin and creatinine in serum. Consider when using Cydophosphamide and Fluconazole combination due to the risk of increased concentration of bilirubin and creatinine in serum.

fentanyl: A death can be due to interaction between fentanyl and fluconazole. Authorities said the patient died from poisoning Fentanyl. Moreover, in a random interference test on 12 healthy volunteers, Fluconazole slowed down the elimination of Fentanyl significantly. The high concentration of fentanyl can lead to respiratory inhibition.

halofantrin: Fluconazole may increase the concentration of halofantrin in plasma due to CYP3A4 inhibitors.

HMG inhibitors - Coa Reductase:

The risk of muscle disease and muscle pattern increases when indicated simultaneously fluconazole with HMG - CoA reducing enzyme inhibitors are metabolized through CYP3A4 such as Atorvastatin and Simvastatin or via CYP2C9 like fluvastatin. If necessary coordinated therapy, patients need to be tested for symptoms of muscle disease and muscle pattern, requiring the concentration of creatine kinase.

It is necessary to stop using HMG - COAs inhibitors if observations of creatine kinase increases or doubt or diagnosis of muscle/muscle pilot disease.

Losartan: Fluconazole inhibits the metabolism of Losartan into the activity of Losartan (E-3174). The E-3174 is the main role that creates Angiotensin II receptor antagonistic activity when treated with Losartan. Patients need to be tested continuously.

methadon: fluconazole can increase the concentration of methadon in serum. Adjusting the dose of methadone may be necessary.

Non -steroid anti -inflammatory (NSAIDs): Flurbiprofen's CMAX increases 23% and Flurbiproofen's AUC increases by 81% when using FlurbiproFen with fluconazole compared to when using Flurbiprofen alone. Similarly, the cmax of the isomer has pharmacological activity [s-(+)-ibuprofen] increases by 15% and the AUC of the isomers with pharmacological activity [S-(+)-ibuprofen] increases 82% when indicated simultaneously fluconazol with ibuprofen racemic (400mg) compared to IBuprofen Racemic. Despite no specific studies, fluconazole has the ability to increase the concentrations of NSAIDs metabolized by CYP2C9 (e.g. Naproxen, Lornoxicam, Meloxicam, Diclofenac). Recommendations to regularly check the harmful effects and toxicity related to NSAIDs. Can adjust the dose of NSAIDs.

Oral contraceptive pills:

2 pharmacokinetic studies with a combined contraceptive pills are done when using multiple doses of fluconazole. In the study with the dose of fluconazole 50mg does not see the effects related to hormones. In the study with the daily dosage of fluconazole per day under the curve of Ethinyl Estradiol and Levonorgestrel increased by 40% and 24% respectively.

Therefore, using multiple doses of fluconazol with the doses on the curve such as no effect on the effectiveness of oral contraceptives.

Phenytoin: Fluconazole inhibits metabolism through the liver of phenytoin. When planning fluconazole with phenytoin, strictly control the heat of phenytoin serum to avoid the toxicity of phenytoin.

Prednison: There is a case of reporting a liver transplant treated with Prednison, an acute adrenal impairment occurs when stopping for 3 months with fluconazol. Stopping Fluconazole assumes that it can increase the activity of CYP3A4, thus leading to increased Prednison metabolism. Patients with long -term treatment with fluconazole and prednison should be strictly controlled for adrenal insufficiency when stopping Fluconazol.

rifabutin: There have been reports on interaction occurred when used simultaneously fluconazole with rifabutin, resulting in an increase in rifabutin levels up to 80% in serum. There have been reports on cases of small vascular inflammation in patients who used to combine fluconazole and rifabutin. Therefore, closely monitoring patients who are taking rifabutin simultaneously with fluconazol.

Saquinavir: Fluconazole increases the area under the curve of Saquinavir by approximately 50%, an increase of CMAX by approximately 55% and reduces Saminavir clearance by approximately 50% due to the inhibition of metabolism through the liver of Saquinavir by CYP3A4 and inhibit P - Glycopruein. Adjusting the dose of Saquinavir may be necessary.

Sirolimus: Fluconazole increases the plasma heat of syrolimus, this cigarette is assumed by fluconazole inhibiting syrolimus metabolism via CYP3A4 and P - Glycoprotein. Fluconazole can be used with syrolimus when adjusting syrolimus dose depends on the ratio/concentration of syrolimus.

sulfonylure: Fluconazole increases the serum selling time in the serum sulfonylure uses a ragged line (for example: chlorpropamid, glibendamid, glipizid, tolbutamid) in healthy volunteers. Recommendation of regular blood glucose control and reduced dose of sulfonylurea appropriately when indicated to close fluconazol with sulfonylurea.

tacrolimus: Fluconazole may increase the concentration of Tacrolimus that specifies the total line in serum 5 times due to the inhibition of the metabolism of Tacrolimusqua Cyp3a4 in the intestine without changes in pharmacokinetics that is observed when indicated Tacrolimus intravenously tacrolimus concentration increases related to kidney toxicity. Reduce oral dose of tacrolimus depends on the concentration of tacrolimus.

Theophylin: In a placebo -controlled study, using 200mg of fluconazole in 14 days reduces 18% of the average plasma clearance rate of theophylin. Therefore, patients who are being treated with high doses of theophylllin or patients at high risk of theophyllin poisoning should be monitored on the signs of theophylin poisoning while treating with fluconazol, which should be adjusted in an appropriate treatment regimen if the signs of toxicity appear.

Tofacitinib: The exposure level with Tofacitinib will increase when used to close Tofacitinib with drugs that cause both CYP3A4 average inhibitor and strong CYP2C19 inhibitors (such as fluconazol). Tofacitinib can be adjusted.

alcaloid coconut: Although not studied, fluconazole may increase the concentration of plasma of shallow coconut alkaloid alkaloids (such as Vincristin and Vinblastin) and lead to neurotoxic toxicity. This can be explained by the inhibition of CYP3 A4 of fluconazol.

Vitamin A: Based on the report of a study in patients prescribed simultaneously fluconazole with trans isomers of Retinoid acid (acid structure of vitamin A), unwanted effects related to the central nervous system are developing fake brain tumors. The phenomenon of fake brain tumor disappears when stopping treatment with fluconazole. Fluconazole can be used with vitamin A but the effects on the central nerve related to unwanted effects need to be considered.

Voriconazole: (CYP2C9, CYP2C19 and CYP3A4 inhibitors):

Simultaneous use of oral voriconazole (400mg, 2 times a day, then 200mg, 2 times in 2.5 days) and oral fluconazole (400mg on the first day, then 200mg/day for the next 4 days) for 6 healthy male volunteers to show increased CMAX and AUC concentration of Voriconazol average of 57% (90% CL: 20%, 10%) and 79% CL: CL: CL: CL: CL: CL: 40%, 128%).

In a clinical study monitoring over eight healthy male volunteers, reducing the dose and/or frequency of voriconazole and fluconazole does not reduce or lose this effect. Unable to simultaneously use voriconazole and fluconazole at any dose.

Zidovudin: Fluconazole increases CMAX and AUC of Zidovudin, respectively, 84%and 74%, as fluconazole reduces the clearance of zidovudin oral 45%. The similar half -of -zidovudine waste time also increased by about 128% when the therapy combined with fluconazole. Patients using this combination therapy should be controlled the appearance of unwanted effects (TDKMM) related to zidovudin. May need to consider reducing zidovudin dosage.

Interactive studies have shown that when using Fluconazole oral Fluconazole with food, cimetidine, antacids or after body radiotherapy in case of bone marrow transplantation, does not significantly reduce the absorption capacity of fluconazole.

Doctors should know that, although interactive studies between drugs and other drugs have not been conducted, such interactions may appear.

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

To be out of reach of children.

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