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DIFLUCAN
DIFLUCAN ONLINE
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine
must be weighed against the good it will do. This is a decision
you and your doctor will make. For the azole antifungals, the
following should be considered:
Allergies—Tell your doctor if you have ever
had any unusual or allergic reaction to any of the azole
antifungals. Also tell your health care professional if you are
allergic to any other substances, such as foods, preservatives, or
dyes.
Pregnancy—Studies have not been done in
pregnant women. However, studies in some animals have shown that
azole antifungals, taken in high doses, may cause harm to the
mother and the fetus. They have caused birth defects in animals.
Before taking these medicines, make sure your doctor knows if you
are pregnant or if you may become pregnant.
Breast-feeding—Azole antifungals pass into
breast milk. Mothers who are taking these medicines and who wish
to breast-feed should discuss this with their doctors.
Children—A small number of children have
been safely treated with azole antifungals. Be sure to discuss
with your child's doctor the use of these medicines in children.
Older adults—Many medicines have not been
studied specifically in older people. Therefore, it may not be
known whether they work exactly the same way they do in younger
adults or if they cause different side effects or problems in
older people. There is no specific information comparing use of
azole antifungals in the elderly with use in other age groups.
Other medicines—Although certain medicines
should not be used together at all, in other cases two different
medicines may be used together even if an interaction might occur.
In these cases, your doctor may want to change the dose, or other
precautions may be necessary. When you are taking azole
antifungals, it is especially important that your health care
professional know if you are taking any of the following:
 | Acetaminophen (e.g., Tylenol) (with long-term, high-dose
use) or
| Amiodarone (e.g., Cordarone) or
| Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone
[e.g., Anavar], oxymetholone [e.g., Anadrol], stanozolol
[e.g., Winstrol]) or
| Androgens (male hormones) or
| Antithyroid agents (medicine for overactive thyroid) or
| Carmustine (e.g., BiCNU) or
| Chloroquine (e.g., Aralen) or
| Dantrolene (e.g., Dantrium) or
| Daunorubicin (e.g., Cerubidine) or
| Disulfiram (e.g., Antabuse) or
| Divalproex (e.g., Depakote) or
| Estrogens (female hormones) or
| Etretinate (e.g., Tegison) or
| Gold salts (medicine for arthritis) or
| Hydroxychloroquine (e.g., Plaquenil) or
| Mercaptopurine (e.g., Purinethol) or
| Methotrexate (e.g., Mexate) or
| Methyldopa (e.g., Aldomet) or
| Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
| Oral contraceptives (birth control pills) containing
estrogen or
| Other anti-infectives by mouth or by injection (medicine for
infection) or
| Phenothiazines (acetophenazine [e.g., Tindal],
chlorpromazine [e.g., Thorazine], fluphenazine [e.g., Prolixin],
mesoridazine [e.g., Serentil], perphenazine [e.g., Trilafon],
prochlorperazine [e.g., Compazine], promazine [e.g., Sparine],
promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril],
trifluoperazine [e.g., Stelazine], triflupromazine [e.g.,
Vesprin], trimeprazine [e.g., Temaril]) or
| Plicamycin (e.g., Mithracin) or
| Valproic acid (e.g., Depakene)—Use of these medicines with
azole antifungals may increase the chance of side effects
affecting the liver |
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| Alprazolam (e.g., Xanax) or
| Diazepam (e.g., Valium) or
| Midazolam (e.g., Versed) or
| Triazolam (e.g., Halcion)—Sedative effects are increased
when taken with itraconazole or ketoconazole. |
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| Amantadine (e.g., Symmetrel) or
| Antacids or
| Anticholinergics (medicine for abdominal or stomach spasms
or cramps) or
| Antidepressants (medicine for depression) or
| Antidyskinetics (medicine for Parkinson's disease or other
conditions affecting control of muscles) or
| Antihistamines or
| Antipsychotics (medicine for mental illness) or
| Buclizine (e.g., Bucladin) or
| Cimetidine (e.g., Tagamet) or
| Cyclizine (e.g., Marezine) or
| Cyclobenzaprine (e.g., Flexeril) or
| Disopyramide (e.g., Norpace) or
| Famotidine (e.g., Pepcid) or
| Flavoxate (e.g., Urispas) or
| Ipratropium (e.g., Atrovent) or
| Meclizine (e.g., Antivert) or
| Methylphenidate (e.g., Ritalin) or
| Nizatidine (e.g., Axid) or
| Omeprazole (e.g., Prilosec) or
| Orphenadrine (e.g., Norflex) or
| Oxybutynin (e.g., Ditropan) or
| Procainamide (e.g., Pronestyl) or
| Promethazine (e.g., Phenergan) or
| Quinidine (e.g., Quinidex) or
| Ranitidine (e.g., Zantac) or
| Sucralfate (e.g., Carafate) or
| Trimeprazine (e.g., Temaril)—Use of these medicines may
decrease the effects of itraconazole and ketoconazole; these
medicines should be taken at least 2 hours after itraconazole
or ketoconazole |
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| Antidiabetic agents, oral (chlorpropamide [e.g., Diabinese],
glipizide [e.g., Glucotrol], glyburide [e.g., DiaBeta,
Micronase], tolbutamide [e.g., Orinase]) or |
| Astemizole (e.g., Hismanal) or
| Terfenadine (e.g., Seldane)—These medicines should not be
taken with fluconazole, itraconazole, or ketoconazole; these
azole antifungals may increase the chance of serious side
effects of astemizole or terfenadine |
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| Atorvastatin (e.g., Lipitor) or
| Cerivastatin (e.g., Baycol) or
| Lovastatin (e.g., Mevacor) or
| Simvastatin (e.g., Zocor)—Use of these drugs with
itraconazole or ketoconazole since increased levels of these
drugs can cause serious muscular disorders. |
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| Busulfan (e.g., Myleran) or
| Docetaxel (e.g., Taxotere) or
| Vinblastine (e.g., Velban) or
| Vincristine (e.g., Oncovin)—Metabolism of these drugs may
be delayed by itraconazole. |
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| Felodipine (e.g., Plendil) or
| Nifedipine (e.g., Procardia) or
| Verapamil (e.g., Isoptin, Covera)—Concurrent use can cause
water retention or slow the heart rate. |
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| Carbamazepine (e.g., Tegretol) or
| Phenobarbital (e.g., Luminal)
| Phenytoin (e.g., Dilantin)—Concurrent use with
itraconazole may decrease itraconazole concentrations.
Phenytoin concentrations may be increased. |
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| Cisapride (e.g., Propulsid)—Cisapride should not be taken
with itraconazole or oral ketoconazole; these azole
antifungals may increase the chance of serious side effects of
cisapride |
| Cyclosporine (e.g., Sandimmune, Neoral)
| Tacrolimus (e.g., Prograf)—Concomitant use may cause
increased concentrations of these drugs, resulting in
toxicity. |
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| Didanosine (e.g., ddI, Videx)—Use of didanosine with
itraconazole or ketoconazole may decrease the effects of
itraconazole or ketoconazole, as well as of didanosine.
Itraconazole and ketoconazole should be taken at least 2 hours
before or 2 hours after didanosine is given |
| Digoxin (e.g., Lanoxin)—Digoxin concentrations may be
increased, resulting in toxicity. |
| Dofetilide (eg., Tikosyn) or
| Pimozide (e.g.,Orap) or
| Quinidine (e.g., Quinaglute, Cardioquin, Quinidex) —Pimozide,
dofetilide and quinidine should not be taken with itraconazole;
itraconazole may increase the chance of serious side effects
of pimozide, dofetilide and quinidine. |
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| Indinavir (e.g., Crixivan) or
| Ritonavir (e.g., Norvir) or
| Saquinivir (e.g., Invirase)—Use of these drugs with
itraconazole or ketoconazole may increase the effects of
indinavir |
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| Isoniazid or
| Rifampin (e.g., Rifadin)—These medicines may decrease the
effects of azole antifungals |
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| Clarithromycin (e.g., Biaxin) or
| Erythromycin (e.g., E-Mycin)—Plasma concentrations of
itraconazole may be increased. |
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| Nevirapine (e.g., Viramune)—Plasma concentrations of
itraconazole or ketoconazole may be decreased. |
| Warfarin (e.g., Coumadin)—Anticoagulant effects may be
increased. |
Proper Use of This Medicine
Ketoconazole and the capsule form of itraconazole should
be taken with a fullmeal. The oral solution form of
itraconazole should be taken on an empty stomach. If you have
any questions about the antifungal medicine you are taking, check
with your health care professional.
For patients taking the oral liquid form of fluconazole,
itraconazole, or ketoconazole:
| Use a specially marked measuring spoon or other device to
measure each dose accurately. The average household teaspoon
may not hold the right amount of liquid. |
If you have achlorhydria (absence of stomach acid) or
hypochlorhydria (decreased amount of stomach acid), and you are
taking itraconazole or ketoconazole, your doctor may want you
to take your medicine with an acidic drink. You may dissolve your
medicine in cola or seltzer water and drink the solution, or your
may take your medicine with a glass of cola or seltzer water. Your
doctor may suggest that you dissolve each capsule or tablet in a
teaspoonful of weak hydrochloric acid solution to help you absorb
the medicine better. Your health care professional can prepare the
solution for you. After you dissolve the tablet in the acid
solution, add this mixture to a small amount (1 or 2 teaspoonfuls)
of water in a glass. Drink the mixture through a plastic or glass
drinking straw. Place the straw behind your teeth, as far back in
your mouth as you can. This will keep the acid from harming your
teeth. Be sure to drink all the liquid to get the full dose of
medicine. Next, swish around in your mouth about one-half glass of
water and then swallow it. This will help wash away any acid that
may remain in your mouth or on your teeth.
To help clear up your infection completely, it is very
important that you keep taking this medicine for the full time of
treatment , even if your symptoms begin to clear up or you
begin to feel better after a few days. Since fungus infections may
be very slow to clear up, you may have to continue taking this
medicine every day for as long as 6 months to a year or more. Some
fungus infections never clear up completely and require continuous
treatment. If you stop taking this medicine too soon, your
symptoms may return.
This medicine works best when there is a constant amount in the
blood. To help keep the amount constant, do not miss any doses
. Also, it is best to take each dose at the same time
every day. If you need help in planning the best time to take
your medicine, check with your health care professional.
Dosing—
The dose of azole antifungals may be different for different
patients. Follow your doctor's orders or the directions on the
label. The following information includes only the average
doses of azole antifungals. Your dose of fluconazole may be
different if you have kidney disease. If your dose is
different, do not change it unless your doctor tells you to
do so.
The number of capsules or tablets, or the amount of oral
suspension or injection that you take depends on the strength of
the medicine. Also, the number of doses you take each day, the
time allowed between doses, and the length of time you take the
medicine depend on the medical problem for which you are taking
azole antifungals.
For fluconazole
| For fungus infections:
| For capsule dosage form:
| Adults—150 milligrams (mg) as a single dose to
treat vaginal yeast infections.
| Children up to 18 years of age—Dose must be
determined by your doctor. |
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| For oral suspension and tablet dosage
forms:
| Adults and teenagers—200 to 400 mg on the first
day, then 100 to 400 mg once a day for weeks or
months, depending on the medical problem being
treated. A vaginal yeast infection is treated with a
single dose of 150 mg.
| Children 6 months of age and older—6 to 12 mg per
kilogram (mg/kg) (2.7 to 5.4 mg per pound) of body
weight on the first day, then 3 to 12 mg/kg (1.35 to
5.4 mg per pound) of body weight once a day for weeks
or months, depending on the medical problem being
treated.
| Infants and children up to 6 months of age—Dose
must be determined by your doctor. |
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| For injection dosage form:
| Adults and teenagers—200 to 400 mg on the first
day, then 100 to 400 mg once a day, injected into a
vein, for weeks or months, depending on the medical
problem being treated.
| Children 6 months of age and older—6 to 12 mg per
kilogram (mg/kg) (2.7 to 5.4 mg per pound) of body
weight on the first day, then 3 to 12 mg/kg (1.35 to
5.4 mg per pound) of body weight once a day, injected
into a vein, for weeks or months, depending on the
medical problem being treated.
| Infants and children up to 6 months of age—Dose
must be determined by your doctor. |
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For itraconazole
| For fungus infections:
| For capsule dosage form:
| Adults and teenagers—200 milligrams (mg) once a
day, which may be increased up to 400 mg once a day
for weeks or months, depending on the medical problem
being treated. Fingernail and toenail infections are
treated with 200 mg one or two times a day for weeks
or months.
| Children up to 16 years of age—Dose must be
determined by your doctor. |
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| For injection dosage form:
| Adults—200 milligrams (mg) twice a day for 4
doses, then 200 mg once a day.
| Children—Dose must be determined by your doctor. |
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| For oral solution dosage form:
| Adults and teenagers—100 to 200 mg once a day for
days or weeks, depending on the medical problem being
treated.
| Children up to 12 years of age—Dose must be
determined by your doctor. |
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For ketoconazole
| For fungus infections:
| For oral dosage form (oral suspension and
tablets):
| Adults and teenagers—200 to 400 milligrams (mg)
once a day for days or weeks, depending on the medical
problem being treated.
| Children over 2 years of age—3.3 to 6.6 mg per
kilogram (1.5 to 3 mg per pound) of body weight once a
day for days or weeks, depending on the medical
problem being treated.
| Infants and children up to 2 years of age—Dose
must be determined by your doctor. |
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Missed dose—
If you miss a dose of this medicine, take it as soon as
possible. This will help to keep a constant amount of medicine in
the blood. However, if it is almost time for your next dose, skip
the missed dose and go back to your regular dosing schedule. Do
not double doses.
Storage—
To store this medicine:
| Keep out of the reach of children.
| Store away from heat and direct light.
| Do not store the capsule or tablet form of this medicine in
the bathroom, near the kitchen sink, or in other damp places.
Heat or moisture may cause the medicine to break down.
| Keep the oral liquid form of this medicine from freezing.
| Do not keep outdated medicine or medicine no longer needed.
Be sure that any discarded medicine is out of the reach of
children. |
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Precautions While Using This Medicine
It is important that your doctor check your progress at regular
visits. This will allow your doctor to check for any unwanted
effects.
If your symptoms do not improve within a few weeks (or months
for some infections), or if they become worse, check with your
doctor.
These medicines should notbe taken with astemizole (e.g.,
Hismanal), cisapride (e.g., Propulsid),dofetilide (e.g., Tikosyn)
or terfenadine (e.g., Seldane). Doing so may increase the
risk of serious side effects affecting the heart.
Liver problems may be more likely to occur if you drink
alcoholic beverages while you are taking ketoconazole. Alcoholic
beverages may also cause stomach pain, nausea, vomiting, headache,
or flushing or redness of the face. Other alcohol-containing
preparations (for example, elixirs, cough syrups, tonics) may also
cause problems. These problems may occur for at least a day after
you stop taking ketoconazole. Therefore, you should not drink
alcoholic beverages or use alcohol-containing preparations while
you are taking this medicine and for at least a day after you stop
taking it.
If you are taking antacids, cimetidine (e.g., Tagamet),
famotidine (e.g., Pepcid), nizatidine (e.g., Axid), omeprazole
(e.g., Prilosec), or ranitidine (e.g., Zantac) while you are
taking itraconazole or ketoconazole, take the other medicine at
least 2 hours after you take itraconazole or ketoconazole .
If you take these medicines at the same time that you take
itraconazole or ketoconazole, they will keep your antifungal
medicine from working properly.
Ketoconazole may cause your eyes to become more sensitive to
light than they are normally. Wearing sunglasses and avoiding too
much exposure to bright light may help lessen the discomfort.
Side Effects of This Medicine
Additional Information
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