Diflucan is a representative of the class of triazole antifungal agents, a powerful selective inhibitor of sterol synthesis in the cells of fungi, used for the treatment of generalized candidiasis, including immunosuppression and cytostatic therapy. Designed for the prevention of fungal diseases of cancer patients undergoing chemotherapy or radiation therapy. Well established in surface skin mycoses and deep endemic mycoses. Fluconazole is indicated for the treatment of the following diseases in adults: Cryptococcal meningitis; invasive candidiasis; mucous candidiasis, including oropharyngial candidiasis, esophageal candidiasis, candidiasis, candidiasis and chronic skin slime; chronic atrophic candidiasis in poor oral hygiene or local treatment; Vaginal candidiasis, acute or recurrent in the absence of local therapy; candidiasis balanitis in the absence of local therapy; dermatophytosis, including foot dermatophytosis, stem dermatophytosis, dermatophytosis, inguinal groin, colored lichen and candidiasis of the skin in the absence of systemic treatment; nail dermatophytosis in the absence of indications for treatment.
Influence on the ability to drive vehicles, mechanisms: when using the drug, it is necessary to take into account the possibility of dizziness and seizures. When transferring a patient from intravenous to oral administration or vice versa, the daily dose does not need to be changed. The solution for intravenous administration contains 0.9% sodium chloride solution; every 200 mg (vial per 100 ml) contains 15 mmol of sodium and chlorine ions (in this regard, in patients who need to limit the consumption of sodium or liquid, it is necessary to take into account the rate of administration of liquid). Treatment should be continued until clinical and hematological remission occurs. Premature termination of treatment leads to relapses. Treatment can be started in the absence of sowing results or other laboratory tests, but if they are available, appropriate correction of fungicidal therapy is recommended. Blood, kidney and liver function should be monitored during therapy. In case of kidney and liver dysfunction, the drug should be discontinued. Hepatotoxic effect of the drug is usually reversible, symptoms disappear after discontinuation of therapy. If there are clinical signs or symptoms of liver damage, which may be associated with the use of fluconazole, the drug should be canceled. Patients with impaired liver function during treatment should be monitored for signs of more serious liver damage. Prothrombin index control is required when used simultaneously with coumarin-type anticoagulants. It is recommended to control the concentration of cyclosporine in the blood of patients receiving fluconazole, as in patients with kidney transplants fluconazole intake in a dose of 200 mg/day leads to a slow increase in the concentration of cyclosporine in plasma. Cases of superinfection caused by strains of Candida other than Candida albicans have been reported, often with natural resistance to fluconazole (e.g. Candida krusei). In such cases, alternative antifungal therapy may be required. If skin rash occurs in patients with immunosuppression, careful monitoring is required, and if the skin reaction progresses, therapy should be discontinued due to the risk of Stevens-Johnson syndrome, Lyell's syndrome. Patients with AIDS are more likely to develop severe skin reactions when using many drugs. If a patient appears in the treatment of surface fungal rash infection, which can be associated with the use of fluconazole, the drug should be canceled. If the rash appears in patients with invasive or systemic fungal infections, they should be carefully monitored and the drug should be canceled if bullous lesions or multiform exudative erythema appear. Concurrent use of fluconazole in doses of less than 400 mg/day and terfenadine is carried out only under careful control. Like other azoles, the drug can cause QT interval prolongation on ECG. When using fluconazole, QT interval increase and ventricular flutter or fluttering were very rarely observed in patients with severe diseases with multiple risk factors, such as organic heart disease, electrolyte imbalance and concomitant therapy contributing to the development of such disorders. Therefore, such patients with potentially proarrhythmic conditions should use the drug with caution. Patients with liver, heart and kidney diseases should consult their physician before using the drug. It is a powerful isoenzyme inhibitor of CYP2C9 and a moderate isoenzyme inhibitor of CYP3A4. It is also an isoenzyme inhibitor of CYP2C19. Caution is recommended when concomitantly treating with drugs with a narrow therapeutic profile, metabolizing isoenzymes of CYP2C9, CYP2C19 and CYP3A4.