Richard.DeWald@f70.n382.z1.fidonet.org (Richard DeWald) (12/10/90)
This is a relatively new drug and I just got some information on it, so I
thought I would post it for the benefits of those who are not up on these
things.
Fluconazole, a triazole antifungal, is an addition to the small group of drugs
available to treat cryptococcal meningitis, serious systemic candidal
infections (including those of the urinary tract, peritoneum and pneumonia),
and oropharyngeal and esophageal candidiasis.
Fluconazole is avalable in formulations for both oral and IV use. The
literature I have (academic, not proprietary) reports that in some clinical
studies it has been as effective as amphotericin B (Fungizone) for systemic
fungal infections, but less likely than amphotericin B or ketoconazole
(Nizoral, another antifungal) to cause serious adverse reactions.
Now the bad news--price. A single 200mg tablet costs the pharmacist more than
$9.00. However, the rationale is that if you can use fluconazole orally as an
alternative to amphotericin B infusions, and if the hospitalization is
shorter, you can save some money. Of course, this selling point is mitigated
by the fact that people are getting amphotericin B at home these days.
Fluconazole is available in Canada.
INDICATIONS: cryptococcal meningitis, serious system candidal infections, and
oropharyngeal and esophageal candidiasis.
PRECAUTIONS: A person who has a known sensitivity to another azole antifungal
could also be sensitive to fluconazole. Fluconazole inhibits liver enzyme
systems that break down drugs, so it could increase serum concentrations for
drugs like warfarin, phenytoin (Dilantin), cyclosporine (Sandimmune) and some
oral antibiotics (tolbutamide (Orinase)). Rifampin (Rifadin) may increase the
metabolism rate of fluconazole, mitigating fluconazole's effectiveness.
ADVERSE REACTIONS: Nausea, vomiting, abdominal pain, diarrhea, headache and
rash.
DOSAGE: for cryptococcal meningitis: 400mg on the first day, followed by 200
to 400mg once a day until the bug is clear from CSF.
for crypotococcal meningitis prophylaxis against relapse (in PWA): 200mg once
a day.
for systemic candidal infections: 400mg first day, 200mg per day after that,
continue for two weeks after symptoms resolve.
for oropharyngeal candidiasis: 200mg first day, 100mg per day until two weeks
after symptoms resolve.
for esophageal candidiasis: 200mg first day, 100mg per day until two weeks
after symptoms have resolved.
Richard DeWald, BSN Student
Univ. of TX - Austin.
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