Antifungal drugs are necessary in case of appearance of unpleasant symptomatology accompanying fungal disease. This problem occurs most often because of reduced immunity. Scientists have found that the potential pathogens of the disease are currently about 400 species of fungus. Every year the need for effective medicines for treatment and prevention increases. Fungal infection of any localization (feet, scalp and body, vaginal candidiasis, oral mucous membranes, etc.) requires immediate and competent treatment. This is not just an unpleasant symptomatology, but also a direct threat to the body of the person affected by the infection, and for others. The cunning of the disease is that it may not manifest itself for a certain period of time. The disease and weakening of the body at some point starts the process and only then there is a negative symptom: itching, burning, redness, peeling. Foot mycosis is the most common of all fungal diseases. In recent decades, there has been a steady upward trend worldwide.
For the treatment сryptococcosis, including cryptococcal meningitis and other localized infections (e.g. lung, skin), including in patients with normal immune response and AIDS, transplant recipients and patients with other forms of immunodeficiency; maintenance therapy to prevent cryptococcosis recurrence in AIDS patients; Generalized candidiasis, including candidaemia, disseminated candidiasis and other forms of invasive candidiasis, such as peritoneal, endocardial, eye, respiratory and urinary tract infections, including in patients with malignant tumours in intensive care settings receiving cytotoxic or immunosuppressive agents, as well as in patients with other factors predisposing to candidiasis; mucous membrane candidiasis, including oral and pharyngeal mucosa, esophagus, non-invasive bronchopulmonary infections, candidiasis, cutaneous and chronic atrophic oral candidiasis (associated with the wearing of dentures), including in patients with normal and suppressed immune function; prevention of recurrence of oropharyngeal candidiasis in AIDS patients; genital candidiasis; acute or recurrent vaginal candidiasis; prophylaxis to reduce recurrence of vaginal candidiasis (3 or more episodes per year); Candida balanitis; prevention of fungal infections in patients with malignant tumors prone to such infections as a result of cytotoxic chemotherapy or radiation therapy; skin mycoses, including foot, body, groin, bran-like lichen, onychomycosis and skin candidiasis infections; deep endemic mycoses in patients with natural .
Inside. The capsules are swallowed as a whole. Therapy can be started before the results of sowing and other laboratory tests are available. However, antifungal therapy needs to be modified accordingly when the results of these studies become known. When a patient is transferred from intravenous to oral administration or vice versa, daily dose changes are not required. The daily dose depends on the nature and severity of the fungus infection. In vaginal candidiasis in most cases, a single dose of the drug is effective. In infections requiring repeated use of the drug, treatment should continue until the clinical or laboratory signs of active fungal infection disappear. Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapses. Use in adults. 1. Cryptococcal meningitis and other cryptococcal infections are usually treated with 400 mg on the first day and then continue to be treated with a dose of 200-400 mg once a day. The duration of treatment for cryptococcal infections depends on the clinical and mycological effects; in cryptococcal meningitis, treatment usually continues for at least 6-8 weeks. To prevent recurrence of cryptococcal meningitis in AIDS patients after a full course of primary treatment, 200 mg/day therapy can be continued for a very long time. 2. In candidaemia, disseminated candidiasis and other invasive candidiasis infections, the dose is usually 400 mg per first day, then 200 mg per day. Depending on the severity of the clinical effect, the dose can be increased to 400 mg/day. The duration of therapy depends on the clinical efficacy. 3. In oropharyngeal candidiasis, the drug is usually used 50-100 mg once a day for 7-14 days. If necessary, patients with a pronounced suppression of immune function can continue treatment for a longer time. In case of atrophic candidiasis of the oral cavity associated with the wearing of dental prostheses, the drug is usually used in a dose of 50 mg once a day for 14 days in combination with local antiseptic agents for the treatment of the prosthesis. In other candidal mucous membrane infections (except genital candidiasis, see below), e.g. esophagitis, non-invasive bronchopulmonary infections, candiduria, skin and mucous membranes, etc., the effective dose is usually 50-100 mg/day with a duration of treatment of 14-30 days. To prevent recurrence of oropharyngeal candidiasis in AIDS patients after completion of a full course of primary therapy with Diflukan, it is possible to use 150 mg once a week. 4. In case of vaginal candidiasis the preparation is applied once inside in dose of 150 mg. To reduce the recurrence rate of vaginal candidiasis, the drug can be used in a dose of 150 mg once a week. Duration of contraindication therapy is determined individually and is usually 6 months. For the prevention of candidiasis in patients with malignant tumors, the recommended dose of the drug is 50-400 mg once a day, depending on the risk of fungal infection. The drug is used a few days before the expected development of neutropenia, and after an increase in the number of neutrophils over 1000 in mm3 treatment continues for another 7 days. 6. In skin infections, including foot mycoses, smooth skin, inguinal area, and in candidiasis infections, the recommended dose is 150 mg per week or 50 mg per day. With bran-like herpes, the recommended dose is 300 mg once a week for 2 weeks; some patients require a third dose of 300 mg a week, while for some patients it is sufficient to take 300-400 mg once a week. An alternative treatment regimen is 50 mg daily for 2-4 weeks. In onychomycosis, the recommended dose is 150 mg once a week. Repeated growth of fingernails on the fingers and feet usually takes 3-6 months and 6-12 months, respectively. However, the growth rate may vary widely among people and also depending on age. After successful treatment of long-lasting chronic infections, changes in nail shape are sometimes observed. 7. In deep endemic mycoses, a dose of 200-400 mg/day may be required. The therapy may last up to 2 years. Duration of therapy is determined individually; it is 11-24 months in coccidioidomycosis, 2-17 months in paracoccidioidomycosis, 1-16 months in sporotrichosis and 3-17 months in histoplasmosis. Application in children. As with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. For children, the daily dose of the drug should not exceed that for adults. The drug is used daily, once a day.
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.