Fluconazole

Fluconazole is an antifungal medication used to treat and prevent a wide range of fungal infections. It works by blocking the synthesis of ergosterol, an essential component of fungal cell membranes, causing the membrane to become leaky and the fungus to die. Fluconazole is particularly effective against Candida species (which cause thrush, vaginal yeast infections, and oral candidiasis) and Cryptococcus species. It is available as a single-dose 150 mg capsule for vaginal candidiasis — one of its most common uses in Nigeria.

Fluconazole is used to treat: - Vaginal thrush (vulvovaginal candidiasis): A single 150 mg oral dose — common use in women - Oral thrush (oropharyngeal candidiasis): Especially common in people with HIV, diabetes, or on inhaled/systemic steroids - Oesophageal candidiasis: Fungal infection of the gullet (common in HIV) - Systemic candidiasis: Fungal infection in the bloodstream or internal organs (in hospitals, intensive care) - Cryptococcal meningitis: A serious fungal brain infection in immunocompromised people (HIV) - Tinea infections: Scalp ringworm (tinea capitis), some cases of body ringworm - Prevention of fungal infections in people undergoing chemotherapy, bone marrow transplant, or with advanced HIV

Take fluconazole exactly as prescribed. Vaginal thrush (most common): - Single oral dose of 150 mg — taken once only - The infection usually improves within 24–48 hours; full resolution within 3–7 days Oral thrush: 50–100 mg once daily for 7–14 days. Severe/systemic infections: Doses up to 400–800 mg daily, intravenous or oral, as directed by a doctor in hospital. - Can be taken with or without food - Take at the same time each day for multi-day courses - For recurrent vaginal thrush (more than 4 episodes per year): A doctor may prescribe weekly fluconazole for 6 months to suppress infection - Complete the full prescribed course for serious infections — a single 150 mg dose is only appropriate for uncomplicated vaginal thrush

Common side effects: - Nausea, stomach pain - Headache - Diarrhoea - Skin rash — report to doctor - Abnormal liver function tests (usually reversible when drug stopped) Serious side effects (rare — stop and seek medical help): - Severe liver damage (hepatotoxicity): Jaundice, dark urine, persistent nausea — rare but can occur with prolonged use or high doses - Serious skin reactions (Stevens-Johnson syndrome) — blistering skin rash, oral ulcers - Heart rhythm abnormality (QT prolongation — rare): Can cause dangerous arrhythmia, especially if combined with certain other medicines - Severe allergic reactions

Important interactions: - Warfarin: Fluconazole significantly increases anticoagulant effect — serious bleeding risk. INR must be closely monitored; warfarin dose usually needs reduction - Statins (atorvastatin, simvastatin): Fluconazole increases statin levels — risk of muscle damage (rhabdomyolysis); avoid simvastatin; use with caution with atorvastatin - Oral hypoglycaemics (glipizide, glibenclamide): Fluconazole increases their effect — risk of severe hypoglycaemia; monitor blood sugar closely - Phenytoin: Fluconazole significantly raises phenytoin levels — risk of phenytoin toxicity; monitor levels - Ciclosporin and tacrolimus: Fluconazole increases levels — risk of kidney toxicity; dose adjustment and monitoring required - Rifampicin (used for TB): Reduces fluconazole levels — higher fluconazole dose may be needed - Methadone: Fluconazole increases methadone levels — risk of QT prolongation - QT-prolonging drugs (amiodarone, haloperidol, quinolones): Increased risk of dangerous heart rhythm — avoid combination or use with extreme caution

Store at room temperature (below 30°C) in a dry place. Oral suspension: store in refrigerator after opening, use within 2 weeks. Keep out of reach of children.