Fluconazole

Fluconazole is an antifungal medicine. It's used to treat infections caused by different kinds of fungus. It can also be used to stop you getting a candida infection. It works by killing the fungus (or yeast) that's causing the infection.

The most common cause of fungal infections is a yeast called candida.

Fluconazole is used to treat many infections caused by candida including:

• thrush in men and women, such as vaginal thrush, skin irritation or inflammation on the head of the penis (balanitis), and thrush in the mouth (oral thrush)
• infections in your blood or elsewhere in your body

It's also used to treat a brain infection called cryptococcal meningitis. This is caused by a fungus called cryptococcus.

Fluconazole can also be used to prevent a fungal infection developing. It's only prescribed if you're likely to get this sort of infection. This includes people who:

• keep getting vaginal thrush
• have a weakened immune system
• have had a bone marrow transplant
• have HIV
• are at risk of getting cryptococcal meningitis

Fluconazole comes as capsules or a liquid that you swallow. It also comes as an injection, but this is usually given in hospital.

Fluconazole is available on prescription. You can also buy it from a pharmacy for vaginal thrush or balanitis (brand names include Azocan and Canesten Thrush Oral Capsules).

For thrush, you can also buy fluconazole capsules with clotrimazole cream from pharmacies (brand names include Canesten Thrush Duo).

Most adults and children aged 16 years old or over can take fluconazole for vaginal thrush or balanitis.

Younger children, and people aged 16 years old and over who need it for other conditions, can take it if it's prescribed by a doctor.

Fluconazole is not suitable for some people. To make sure it's safe for you, tell a pharmacist or your doctor before taking it if you have:

• ever had an allergic reaction to fluconazole or any other medicine
• a heart condition, including heart rhythm problems (arrhythmia)
• kidney or liver problems
• a rare, inherited blood disorder called acute porphyria
• had a blood test that showed you have abnormal levels of potassium, calcium or magnesium

Fluconazole capsules are either 50mg, 150mg or 200mg.

The liquid usually comes in 2 different strengths:

• 50mg of fluconazole in a 5ml spoonful (50mg/5ml)
• 200mg of fluconazole in a 5ml spoonful (200mg/5ml)

The usual doses for adults are:

• oral (mouth) thrush – 50mg a day, taken for 7 to 14 days
• vaginal thrush or balanitis – 150mg, taken as a single dose
• vaginal thrush that keeps coming back – 150mg, taken once every 72 hours for the first 3 doses, then 150mg once a week for 6 months
• candida infections (in your blood or elsewhere in your body) – 200mg to 800mg a day for several weeks
• cryptococcal meningitis – 200mg to 800mg a day for several weeks
• to stop cryptococcal meningitis coming back – 200mg a day, taken long term
• to prevent fungal infections if you have a weakened immune system and a low white blood cell count – 50mg to 400mg a day, until your white blood cell count improves

For children, your child's doctor will work out the right dose depending on the infection and your child's age and weight.

You can take fluconazole capsules and liquid with or without food.

Swallow the capsules whole with a drink of water. It's best to take your capsules at the same time each day.

If you're taking the liquid, use the plastic spoon that comes with your medicine to measure your dose. If you do not have a plastic spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long you take fluconazole for depends on why you're taking it and whether your infection is getting better.

It could be a single dose for vaginal thrush or balanitis. Treatment may continue for several weeks, months or even years if you have another type of infection, or you're taking it to prevent infections.

If your doctor prescribes a course of fluconazole, they'll advise you on how long to take it for. Keep taking your medicine until the course is finished, even if you start to feel better. This will help to stop the infection coming back.

Speak to your doctor if you want to stop taking it for any reason.

It's important to complete the course of fluconazole even if you feel better.

If you forget a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just skip the missed dose and take your next one at the usual time.

Do not take 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

If you take your fluconazole once every 72 hours, or once a week, it may help to use a calendar and mark the days when you need to take it.

Taking 1 or 2 extra doses of fluconazole is unlikely to harm you.

• your child takes more than the recommended dose of fluconazole
• you take more than the recommended dose of fluconazole and have side effects or feel unwell

Go to 111.nhs.uk or call 111 . Call 111 if you need advice for a child under 5 years.

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the fluconazole packet or leaflet inside it, any remaining medicine, and any other medicines you take.

These common side effects of fluconazole happen in more than 1 in 100 people. There are things you can do to help cope with them:

Rest and drink plenty of fluids. Do not drink too much alcohol. Ask a pharmacist to recommend a painkiller if you need one.

Talk to your doctor if the headaches last longer than a week or are severe.

Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help.

If you're in a lot of pain, speak to a doctor or pharmacist.

Drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

If you take the combined contraceptive pill or the progestogen-only pill and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Stick to simple meals and do not eat rich or spicy food. It might help to take your fluconazole after a meal or snack.

If you're being sick, try small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee.

If you take the combined contraceptive pill or the progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is right for you.

If the rash gets worse, or does not get better, speak to your doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects are uncommon and happen in less than 1 in 100 people.

Call a doctor or call 111 immediately if:

• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin, or if you have pale poo and dark pee – these can be signs of liver problems
• you bruise more easily or get infections more easily – these can be signs of a blood disorder
• you have a faster or irregular heartbeat

Serious allergic reaction

It happens rarely but it's possible to have a serious allergic reaction (anaphylaxis) to fluconazole.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of fluconazole. For a full list, see the leaflet inside your medicine packet.

Fluconazole may sometimes be prescribed during pregnancy but only if other treatments have not worked.

If you have thrush, your GP will probably prescribe clotrimazole, or a similar antifungal medicine, first. This may be as a cream or as a soft tablet (a pessary) that you put into your vagina.

If the thrush does not go away, you should discuss the risks and benefits of taking an oral treatment for thrush with your GP.

If your doctor or health visitor says your baby is healthy, you can take fluconazole when you're breastfeeding.

There is not much information about how much fluconazole passes into breast milk, but information shows that the amounts are fairly high compared to most other medicines. However, the amounts are still lower than doses used to treat babies who have a fungal infection themselves.

It's been used for many years without side effects in breastfed babies. Occasionally, mild side effects have been reported, such as being sick or diarrhoea.

Fluconazole is sometimes used to treat a fungal infection of the breast, known as breast candidiasis. However, the amount that passes into breast milk is not enough to treat the baby if they also have a fungal infection. Your baby will need their own treatment.

If you notice that your baby is not feeding as well as usual, or has an upset stomach such as being sick or diarrhoea, or if you have any other concerns about your baby, then talk to your midwife, health visitor, pharmacist or doctor.

There is no evidence to suggest that fluconazole reduces fertility in either men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Some medicines and fluconazole can affect each other.

Tell your doctor if you're taking any of these medicines before you start taking fluconazole:

• pimozide, quetiapine, amisulpride, haloperidol, lithium or risperidone – used to treat some kinds of mental health conditions
• escitalopram or venlafaxine – used for treating depression
• erythromycin or clarithromycin – antibiotics
• ergotamine – used for migraine or headaches
• amiodarone – used for heart problems
• warfarin, dabigatran or clopidogrel – medicines used to help prevent blood clots
• carbamazepine – for epilepsy and nerve pain
• losartan – for high blood pressure and heart failure
• statins – for high cholesterol

These are not all the medicines that can affect fluconazole. For a full list, see the leaflet inside your medicines packet.

There's not enough information to say that complementary medicines, herbal remedies and supplements are safe to take with fluconazole. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.