Diflucan online in Australia

What is Diflucan used for?

In adults

· Neuromeningeal cryptococcosis:

§ Attack treatment: its effectiveness has been demonstrated, mainly in AIDS patients. During other types of immunosuppression (organ transplantation, hemopathies), in immunocompetent patients and in severe forms, the site of fluconazole is not well understood compared to amphotericin B. The latter appears to sterilize the CSF more rapidly.

§ Fluconazole is also indicated for the maintenance treatment of cryptococcosis in AIDS patients. Then it must be prescribed indefinitely.

§ The efficacy of fluconazole in other cryptococcal pulmonary or skin locations is less established.

Systemic candidiasis including disseminated and deep candidiasis (candidemia, peritonitis), esophageal candidiasis, and urinary candidiasis. Candida albicans represents the majority of the species isolated in clinical studies.

Efficacy in infections caused by other Candida species, including Candida glabrata and Candida kruseï (generally resistant), has not been established.

Prevention of sensitive Candida infections in adults exposed to severe and prolonged neutropenia during the induction and consolidation treatment of acute leukemias and undergoing a hematopoietic stem cell allograft.

In infants and children

Treatment of oropharyngeal candidiasis in immunocompromised children

Treatment of systemic candidiasis, including disseminated and deep candidiasis (candidemia, peritonitis), esophageal candidiasis, and urinary candidiasis.

· Treatment of neuromeningeal cryptococcosis; Maintenance treatment during AIDS should be continued indefinitely.

Conditions for which this medicine may be prescribed

• Neuromeningeal cryptococcosis
• Neuromeningeal cryptococcosis in AIDS
• Systemic candidiasis
• Disseminated candidiasis
• Candidiasis of the peritoneum
• Esophageal candidiasis
• Urinary yeast infection
• Prevention of candidiasis in adults treated for acute leukemia with allograft
• Oropharyngeal candidiasis in immunocompromised children
• Systemic candidiasis in children.

Method of administration and dosage of the medicine Diflucan

Dose

The choice of oral or intravenous route of administration depends on the clinical condition of the patient.

A change of route of administration does not change the daily dose.

Fluconazole can be administered as an intravenous infusion at a maximum rate of 10 ml / min.

As fluconazole is available in saline, in patients requiring sodium or water restriction, this element should be considered. This medicine contains 0.155 millimoles (3.57 mg) of sodium / ml solution for injection.

It can be administered concomitantly with:

a) 20% glucose solution

b) Ringer's solution

c) Hartmann's solution

d) potassium chloride in glucose solution

e) baking soda.

To date, during clinical trials and during administration, no incompatibility with other products has been observed. However, as a precaution, it is recommended not to mix the fluconazole infusion with other products.

In adults

Cryptococcosis:

Candidiasis:

· Prevention of candidiasis.

The recommended dose is 400 mg / day once a day. Fluconazole should be started as soon as chemotherapy or graft conditioning is started. It should continue for up to 7 days after the increase in polymorphonuclear neutrophil levels above 1000 / mm3 or for a longer period (up to 75 days).

The duration of treatment depends on the clinical response.

In premature infants, term infants and up to 28 days of life.

Their kinetic data suggests slower clearance in this age group. However, the fragmented nature and insufficient clinical data currently do not allow us to propose a dose.

In infants and children

Treatment of oropharyngeal candidiasis in immunocompromised children: the recommended dose is 3 mg / kg / day every 24 h.

Treatment of systemic candidiasis, including disseminated and deep candidiasis (candidemia, peritonitis), esophageal candidiasis and urinary candidiasis: the recommended dose is 6-12 mg / Kg / d every 24 hours, depending on the severity of the disease.

· Treatment of neuromeningeal cryptococcosis; Maintenance treatment during AIDS should be continued indefinitely: the recommended dose is 6-12 mg / kg / day every 24 hours, depending on the severity of the disease.

In the elderly

The prescription will be prudent.

The dose will be adjusted according to the creatinine clearance number.

In the absence of kidney failure, the usual recommended dose in adults will be adopted.

In patients with renal impairment (creatinine clearance ≤ 50 ml / min), the dose will be adjusted as described below.

Renal insufficiency

Fluconazole is mainly excreted unchanged in the urine.

An initial dose of 100 to 400 mg will be administered at the start of fluconazole therapy in patients with renal impairment. After a first administration, the daily dose will be adjusted according to the indication and the table below.

In children with renal impairment, a loading dose of 3 mg / kg will be administered. Then the maintenance dose will be adapted, as in adults, according to the table.

Administration form

Form to use in children

Possible side effects of the drug Diflucan

• Sickness
• Flatulence
• Abdominal pain
• Diarrhea
• Eruption
• Stevens-Johnson syndrome
• Lyell syndrome
• Alopecia
• Headache
• Increased transaminases.
• Hepatic injury
• Asthenia
• Anorexy
• Vomiting
• Jaundice
• Neutropenia
• Agranulocytosis
• Thrombocytopenia
• Anaphylactic reaction
• QT prolongation interval
• Torsades de pointes

Show more Gastrointestinal and skin effects are the most common side effects.

Gastrointestinal effects: nausea, flatulence, abdominal pain, diarrhea.

Allergies and effects on the skin: skin rash, severe skin reactions such as bullous toxidermia (Steven-Johnson syndrome, Lyell syndrome, especially during AIDS), anaphylactic reactions.

In general, reversible alopecia has been reported.

General effects: headache that may be related to the product.

Hepatic effects: increased liver transaminases generally reversible at the end of treatment, severe liver damage possibly associated with elevated serum fluconazole levels (see section Special warnings and precautions for use), sometimes fatal events have been exceptionally reported.

Hematological effects: leukopenia (neutropenia, agranulocytosis), thrombocytopenia.

Contraindications: when not to use this medicine?

• Fluconazole hypersensitivity
• Derivatives of hypersensitivity to triazole
• Pregnancy
• Lack of effective female contraception
• Breastfeeding

Fluconazole MUST NOT BE GIVEN in the following cases:

Hypersensitivity to fluconazole and / or other azole derivatives.

· Pregnancy and lactation (see section Pregnancy and lactation).

· In association with:

§ cisapride

§ pimozide and

§ halofantrine

(See section Interactions with other medications and other forms of interaction).

Presentation of this medicine

200 ml (PVC) pockets. Box of 10.

Appearance and shape

Lack of information in the AMM. Diflucan: its other forms

• FLUCONAZOLE PANFARMA 2 mg / ml, solution for infusion, box of 10 bags of 50 ml.
• FLUCONAZOLE PANFARMA 2 mg / ml, solution for infusion, box of 10 bags of 100 ml.

Composition of the drug Diflucan

* per unit dose Active ingredients: fluconazole Excipients with known effects? : Presence of: sodium Other excipients: sodium chloride, water for injections, effects on ability to drive and use machines

Aimlessly.

Warnings and precautions for use

• Hepatic injury
• Kidney damage
• Liver test abnormality
• Blistering lesion
• Long QT
• Torsades de pointes
• Patient with proarrhythmogenic conditions.
• Dehydrated diet
• Low sodium diet
• Premature
• Newborn
• Woman of childbearing age

Show more In patients with known liver and / or kidney damage, as well as when severe pathology is associated, monitoring of liver tests is recommended; Discontinuation of fluconazole treatment will be considered if a previous liver test abnormality worsens.

The patient should be informed that in case of symptoms suggestive of severe liver damage (severe asthenia, anorexia, persistent nausea, vomiting, jaundice), treatment with fluconazole should be discontinued immediately and a physician should be consulted.

Special clinical follow-up is required in patients who have previously had a skin reaction associated with taking fluconazole or another azole derivative. The patient should be informed that if bullous lesions occur, fluconazole should be discontinued immediately and that a physician should be consulted as soon as possible.

This medicine contains 3.57 mg (or 0.155 mmol) sodium per ml of solution for injection, keep this in mind in people on a strict sodium diet.

Mechanism of action: how does it work?

Pharmacotherapeutic group: ANTIMICOS FOR SYSTEMIC USE,

ATC code: J02AC01.

(J: anti-infective)

Fluconazole is a bistriazole antifungal agent that can be used orally and injected intravenously.

Fluconazole works by inhibiting ergosterol biosynthesis of fungal origin. It is more specific for the synthesis of sterols in fungi than that of sterols in mammals.

Fluconazole's in vivo activity appears to be much more marked than might be expected from in vitro tests.

Generally sensitive species

Candida and in particular albicans

Cryptococcus neoformans

Generally resistant species

Candida kruzeï

Dermatophytes (microsporum, trichophyton)

Aspergillus sp.

Interactions: do not take this medicine with ..

Fluconazole exerts a very specific activity on cytochrome P 450 dependent enzymes of fungal origin.

Contraindicated associations

+ Cisapride

Increased risk of ventricular rhythm disturbances, especially torsade de pointes.

+ Pimozide

Increased risk of ventricular rhythm disturbances, especially torsade de pointes.

+ Halofantrine

Increased risk of ventricular rhythm disturbances, especially torsades de pointes.

Associations subject to precautions for use.

+ Alfentanil

Increased respiratory depressant effect of the opioid analgesic due to decreased liver metabolism.

Adjust the dose of the opioid pain reliever if you are taking fluconazole.

+ Oral anticoagulants

Increased effect of the oral anticoagulant and the risk of bleeding due to the reduction of its hepatic metabolism.

More frequent monitoring of the prothrombin level and monitoring of the INR: adjustment of the dose of the oral anticoagulant during treatment with fluconazole and 8 days after its discontinuation.

+ Cyclosporine

Risk of increased blood levels of the immunosuppressant (inhibition of its metabolism) and serum creatinine.

Determination of immunosuppressant blood concentrations, control of renal function and adaptation of its dose during the combination and after its interruption.

+ Nevirapine

Doubling of nevirapine concentrations with risk of increasing its undesirable effects. Clinical monitoring and possible adaptation of the nevirapine dose.

+ Phenytoin (and by extrapolation, phosphenytoin)

Increased plasma phenytoin concentrations that can reach toxic values. Mechanism invoked: inhibition of hepatic metabolism of phenytoin.

Close clinical surveillance, determination of plasma phenytoin concentrations and possible dose adjustment during fluconazole treatment and after discontinuation.

+ Sulfonylureas

Increased half-life of sulfonamide with possible appearance of hypoglycemic manifestations.

Warn the patient of the risk of hypoglycemia, reinforce glycemic self-control and adjust the dose of sulfonamide during treatment with fluconazole.

+ Rifampicin

Decreased plasma concentrations and the efficacy of the two anti-infectives (enzyme induction by rifampicin and decreased intestinal absorption by antifungal azole).

Separate the doses of the two anti-infectives, monitor the plasma concentration of the antifungal azole, and possibly adjust the dose.

+ Rifabutin

Risk of increased adverse effects of rifabutin (uveitis): increased plasma concentrations and its active metabolite.

Regular clinical monitoring.

+ Theophylline (base and salts) and aminophylline

Increased theophyllinemia with risk of overdose (decreased theophylline clearance).

Clinical monitoring and possibly theophyllinemia; If necessary, adjust the theophylline dose during and after discontinuation of fluconazole.

+ Triazolam

Increased plasma concentrations of triazolam by decreasing liver metabolism with increased sedation.

Clinical follow-up and possible dose adjustment of triazolam during treatment with fluconazole.

+ Tacrolimus

Possible increase in circulating concentrations of tacrolimus (inhibition of hepatic metabolism) and serum creatinine.

Strict control of renal function, determination of circulating tacrolimus concentrations and possible dose adjustment.

Associations to consider

+ Losartan

Risk of decreased effectiveness of losartan by inhibiting the formation of its active metabolite by fluconazole.

+ Others

In the absence of clinical studies, the association of fluconazole with xanthic bases and INH must be careful: then clinical or even biological monitoring is necessary.

Diuretics: An increase in plasma levels (40%) of fluconazole has been observed in healthy volunteers receiving hydrochlorothiazide simultaneously. Although it cannot be excluded, this increase does not require a dose adjustment of fluconazole in patients with diuretics.

Fluconazole multi-dose interaction studies have shown:

At the 50 mg / day dose, there are no changes in estrogen-progestin kinetics in women;

At the dose of 200 to 400 mg / day in healthy male volunteers, there is no effect on the level of steroid hormones or on the response of the stimulation test to ACTH.

Fluconazole administered 50 mg / day for 28 days did not affect plasma testosterone levels in men and levels of steroid hormones in women of childbearing age.

There have been no changes in fluconazole absorption that may have clinical consequences during food interaction studies, cimetidine, antacids, total body irradiation in bone marrow transplants.

Although no interaction studies have been conducted between fluconazole and zidovudine and / or pentamidine, these drugs have been used simultaneously in AIDS patients with no significant difference in incidence. No side effects have been observed.

Interaction studies with antipyrine indicate that your metabolism is not affected by fluconazole administered as a single dose or as repeated doses.

Incompatibilities

In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products except those mentioned in Dosage and method of administration: 20% glucose solution, Ringer's solution, Hartmann's solution, potassium chloride in glucose solution, bicarbonate of sodium.

How to react in case of overdose?

In case of overdose, treatment is symptomatic with proper care and gastric lavage if necessary. Fluconazole is largely excreted in the urine; its elimination is favored by induced diuresis. A 3-hour hemodialysis session reduces plasma levels by approximately 50%.

FLUCONAZOL PANFARMA: Pregnancy, lactation and fertility

Pregnancy

Experimental studies in animals do not exclude the possibility of a teratogenic effect and in the human species the data is insufficient to specify the risk. Therefore, the prescription of fluconazole is contraindicated during pregnancy, except in patients with severe or life-threatening fungal infections where fluconazole can be used if the expected benefit is greater than the risk to the fetus. . In women of childbearing age, effective contraceptive means should be introduced.

Breastfeeding

The concentrations of fluconazole found in milk are similar to those of plasma, so fluconazole is contraindicated during the lactation period.