Treatment should be continued until the replacement of the infected nail (uninfected nail sprouting). For the re-growth of nails on the fingers and feet normally requires 3-6 months. and 12.6 months, respectively. In deep endemic mycosis may require the use of the drug in a dose of 200 mg (4 capsules of 50 mg) – 400 mg (8 capsules 50 mg) per day for up to 2 years. The duration of therapy is determined individually; it can be 11-24 months. with coccidioidomycosis; 2-17 months. When stanozol paracoccidioidomycosis; 1-16 months. with sporotrichosis and 3-17 months. at histoplasmosis. In children, as well as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. In children, the drug should not be applied in a daily dose that would be higher than that in adult, i.e. no more than 400 mg per day. The drug is used every day 1 time per day.
Side effect From the digestive system: loss of appetite, changes in taste, nausea, vomiting, abdominal pain, flatulence, diarrhea, rarely – liver dysfunction (hyperbilirubinemia, increased alanine aminotransferase activity, aspartate aminotransferase, increased activity of alkaline phosphatase, jaundice, hepatitis, hepatocellular necrosis ). From the nervous system: headache, dizziness, excessive fatigue, rarely – seizures. From the side of hematopoiesis: rarely – leukopenia, thrombocytopenia (bleeding, petechiae), neutropenia, agranulocytosis. On the part of the cardiovascular system: an increase in the duration of the interval stanozol, flickering / ventricular flutter. Allergic reactions: skin rash, rarely – exudative erythema multiforme (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell’s syndrome), anaphylactoid reactions (including angioedema, facial swelling, hives, itching of the skin). Other: rarely – renal dysfunction, alopecia, hypercholesterolemia, hypertriglyceridemia, hypokalemia.
Overdose symptoms: hallucinations, paranoid behavior. Treatment is symptomatic: . Gastric lavage, forced diuresis Haemodialysis for 3 hours decreases the plasma concentration of approximately 50%.
Interaction with other drugs
When using fluconazole and warfarin increased the prothrombin time (an average of 12%). In this connection, it is recommended to closely monitor the performance of the prothrombin time in patients receiving the drug in combination with coumarin anticoagulants.
May increase the half-life of oral hypoglycemic agents – sulfonylureas (chlorpropamide, glibenclamide, glipizide, tolbutamide) while receiving fluconazole.
Concomitant use of fluconazole phenytoin and may lead to an increase in the plasma concentration of phenytoin to a clinically significant degree. Therefore, if necessary, the joint use of these drugs need to monitor the concentration of phenytoin with the dose adjusted to maintain drug levels within the therapeutic range.
Combination with rifampschinom stanozol leads to decrease by 25% and shorten the half-life of fluconazole from plasma by 20%. Therefore, patients receiving concomitant rifampicin, the dose of fluconazole is expedient to increase.
It is possible increase of cyclosporine concentrations with the simultaneous use of fluconazole 200 mg / day.
In the case of simultaneous reception with theophylline may reduce the average clearance of theophylline plasma velocity.
With the simultaneous use of fluconazole and cisapride concentration cisapride plasma can significantly increase; described cases of adverse reactions on the part of the heart, including . flicker / ventricular flutter including (torsades de points), an increase in the QT interval on the ECG
Simultaneous administration of azole antifungals and terfenadine may lead to a significant increase in the level of terfenadine in the plasma. may cause serious arrhythmias by increasing the interval
Concomitant use of fluconazole and hydrochlorothiazide may lead to an increase of 40% in the plasma concentration of fluconazole.
There have been reports about the interaction of fluconazole and rifabutin, the latter accompanied by an increase in serum levels. With simultaneous use of fluconazole and rifabutin uveitis cases are described. We must carefully monitor patients while receiving rifabutan and fluconazole.
Patients receiving the combination of fluconazole and zidovudine, increasing the concentration of zidovudine observed, which is caused by a decrease in the conversion of the latter into its main metabolite, so you should expect an increase in the side effects of zidovudine.
Increasing the concentration of midazolam, in connection with the what increases the risk of psychomotor effects (more pronounced when using fluconazole inside than intravenously).
increasing the concentration of tacrolimus and therefore increases the risk of nephrotoxicity.
Treatment should continue until clinical remission. Premature discontinuation of treatment leads to relapse.
In rare cases, the use of fluconazole was accompanied by toxic liver changes, including fatalities, primarily in patients with serious underlying medical conditions. In the case of hepatotoxic effects associated with fluconazole, no obvious dependence of the total daily dose, duration of treatment, gender, and age of the patient. Hepatotoxic effects of fluconazole was usually reversible; its signs disappeared after discontinuation of therapy. When clinical signs of liver damage, which may be associated with fluconazole, the drug should be discontinued.
AIDS patients are more prone to the development of severe skin reactions in the application of many drugs. In cases where patients with superficial fungal infection develops a rash, and she is regarded as definitely related to fluconazole, the drug should be discontinued. When a rash in patients with invasive / systemic fungal infections, they should be monitored closely and fluconazole cancel the appearance of bullous erythema multiforme or changes. Care must be taken while taking fluconazole with rifabutin or other drugs metabolized by the cytochrome stanozol system.
When combined fluconazole and oral hypoglycemic agents (chlorpropamide, glibenclamide, glipizide, tolbutamide) in patients with diabetes should monitor blood glucose levels (possibility of hypoglycemia). It is recommended to monitor blood concentration of cyclosporine while the use of fluconazole.
Patients who concurrently with fluconazole receiving high dose theophylline or who have a chance of developing theophylline intoxication dolzhnynahoditsya monitored for early detection of the symptoms of theophylline overdose.